aged care australia winter 2010

www.agedcareassociation.com.au www.adbourne.com

ACAA OFFICE HOLDERSPRESIDENT Bryan DormanVICE PRESIDENT Francis CookDIRECTORS Tony Smith Mary Anne Edwards Viv Padman Geoff Taylor Kevin O’SullivanEDITOR Rod YoungPRODUCTION Jane Murray

ACAA OFFICESFEDERAL PO Box 335, Curtin ACT 2605T: (02) 6285 2615 F: (02) 6281 5277E: [email protected] W: www.agedcareassociation.com.au

ACAA - NSWPO Box 7, Strawberry Hills NSW 2012T: (02) 9212 6922 F: (02) 9212 3488E: [email protected] W: www.acaansw.com.au Contact: Charles Wurf

ACAA - SA Unit 5, 259 Glen Osmond Road Frewville SA 5063T: (08) 8338 6500 F: (08) 8338 6511E: [email protected] W: www.acaasa.com.au Contact: Paul Carberry

ACAA - TASPO Box 208, Claremont TAS 7011T: (03 6249 7090 F: (03) 6249 7092E: [email protected]: Tony Smith

ACAA - WA Suite 6, 11 Richardson StreetSouth Perth WA 6151T: (08) 9474 9200 F: (08) 9474 9300E: [email protected]: www.acaawa.com.au Contact: Anne-Marie Archer

AGED & COMMUNITY CARE VICTORIALevel 7, 71 Queens RoadMELBOURNE VIC 3000T: (03) 9805 9400 F: (03) 9805 9455E: [email protected] W: www.accv.com.auContact: Gerard Mansour

AGED CARE QUEENSLAND PO Box 995, Indooroopilly QLD 4068T: (07) 3725 5555 F: (07) 3715 8166E: [email protected] W: www.acqi.org.auContact: Anton Kardash

49 67

AdbourneP U B L I S H I N G

ADvERtISIng Melbourne: Neil Muir (03) 9758 1433Adelaide: Robert Spowart 0488 390 039

PRODuCtIOnClaire Henry (03) 9758 1436

ADmInIStRAtIOnRobyn Fantin (03) 9758 1431

DISCLAImER Aged Care Australia is the regular publication of Aged Care Association Australia. Unsolicited contributions are welcome but ACAA reserves the right to edit, abridge, alter or reject any material. Opinions expressed in Aged Care Australia are not necessarily those of ACAA and no responsibility is accepted by the Association for statements of fact or opinions expressed in signed contributions. Aged Care Australia may be copied in whole for distribution among an organisation’s staff. No part of Aged Care Australia may be reproduced in any form without written permission from the article’s author.

Adbourne PublishingPO Box 735 Belgrave, VIC 3160

Aged Care Australiais the official quarterly journal for the Aged Care Association Australia

Front Cover: Tania Jose, Registered Nurse, working at the nurses station at Mosman Trust – Peter Cosgrove House. Photo courtesy of Caroline Lee, Director and CEO, leecareplus.

20

63 Reduce training costs, improve learning outcomes – Online Training 64 PROVEN* 10% Saving of Energy Contracts via the Auction Process 65 Heath care reform – the aged care chapter

Editorial 67 ACAA Building Awards 72 Falls-Related Traumatic Brain Injury in Older People 73 Fragile Facilities: Regulatory Non-Compliance That May Lead To Sanctions 77 Aged Care Reform – ACAA Recommendations 79 Better Oral Health in Residential Care Training

80 Calendar of Events

81 Product news

Profiles 45 Bill Deveney 49 ‘My Father, still driving at 100!’ – A profile of Percy Clayton, by Mike Swinson, told through the eyes of his only daughter Carole

Finance 52 Guide To A Better Year End Audit Experience 53 When Date of Entry isn’t Date of Entry

Workforce 56 Flexibility is the Key 59 Industry Feedback

Sponsor Articles 60 Guild Lawyers’ John Kelly appointed Acting Aged Care Commissioner 61 Notes from an Architect’s Diary – Aged Care Projects

contents

national update 3 CEO’s Report 5 Presidents Report 6 State Reports 17 Congress 2010

technology 20 How do you make a great organisation even better? e-health! 27 Healthcare Identifiers - The right information at the right place, at the right time 29 Aged Care IT Vendors Speak Out 32 Overton Lea takes charge of incontinence management 35 ITAC 2010 39 E-Health that Just Works 41 Improving Aged Care through improving technology

Aged Care AustraliaWinter 2010Voice of the aged care industry

aca Aged Care Australia | Winter 2010 | 3

national update

CEO’s Report

W ith the Productivity Commission (PC) now scheduled to deliver its final

report to Government by April 2011 it is essential that the whole industry coordinates our efforts to pressure Government and Opposition to commit to the necessary reform and not allow the options which the PC will undoubtedly put on the table to pass without response and action for another ten years.

To maximize the likelihood of success it is essential that the CCOA campaign garners maximum support from the industry; which means all of us working together to bring the common messages from CCOA to politicians and candidates from the major parties as we progress to the 2010 election.

Beyond the election, it will be essential to maintain the pressure on Government and Opposition up till budget night in May 2011. Only through maintaining this level of industry pressure can we ensure that the Government, of the day, will respond in a timely fashion and that their decisions will be the best solutions to meet the industry’s ongoing needs for future sustainability.

Below is some of the materials we have been working on to ensure a common message from the industry and a range of resources to help providers, staff, residents, relatives and the broader community to support this very important campaign. It is essential if we hope to succeed that we maximize the community support for the campaign and create a crescendo of voices calling for reform.

ACAA is seeking your assistance by joining the campaign, seeking support from your colleagues, your residents their relatives and friends and the broader community.

Older Persons Pairing CampaignThe Grand Plan, a new vision for the care of older Australians, is matching up younger people with Grand (older) people who might be friends, mentors, relatives – anyone who has played an important role in their lives.

The “pairings” will be used to illustrate the Grand relationships in our lives and remind Australians why choice and access to affordable quality aged care should be an entitlement for all older people.

Please join with thousands of other Australians and access this site, send a message to the grand person in your life, or use the site to send a message to your local politician; tell your local pollie what you want, to ensure the best support and services are available for our older citizens in the future.

www.thegrandplan.com.au

More details on CCOA and access to CCOA media releases can be found at www.agedcareassociation.com.au/CCOA n

COALItIOn for CARE of OLDER AuStRALIAnS (CCOA)

The Coalition for Care of

Older Australians (CCOA) is

an overarching organization

of the major church and

charitable aged care

providers and the two major

industry peak bodies coming

together under a single

umbrella to unite the aged

care industry with a single

voice, a common message

with specific objectives to

deliver on reforms for our

industry to make aged care

sustainable and viable for

the next quarter century.

Rod Young CEO, ACAA


national update

President’s ReportW ith its appointment to

undertake its “Caring for Older Australians” (April 2010)

review, one expects the Productivity Commission has a detailed and comprehensive knowledge of the issues of Aged Care going forward and will be equipped to present a model that will be attractive, functional and appropriate in its structure, such that Government will accept it.

ACAA was invited by the Government to submit its comments and thoughts prior to the framing of the Commission’s Terms of Reference, and in general terms, believes that the broad range of issues as well as a comprehensive review of the long term structural reforms can be addressed within these Terms . ACAA encourages its members to participate in this review where possible, by making their individual and collective submissions and views known to the Commission during the period of review, ultimately leading to a final report in April 2011. You may find out more about this review at the Commission’s website (http://www.pc.gov.au/).

Naturally, it will be some time, probably years, before the full effect of any of the Commission’s recommendations will address the current stresses and pressures on the Industry.

In the ACAA press release endorsing the review process, we also cautioned that, as it was some time to implementation of any of the Commissions findings, it was essential that Government recognizes that a number of short term solutions were essential to ensure the industry remains viable during any transition process to a re-structured system.

As we stand today, this has not occurred. As of the most recent Budget announcements, Government has failed to address the key short-term critical issues of this industry, those being Viability and Capital.

As to viability and since the introduction of COPO as the indexation determinant for this Industry, industry workforce

Productivity is apparently the key!

The Productivity

Commission has now been

appointed to undertake

a fourth aged care

industry evaluation. It has

produced reports on Policy

Implications of an Ageing

Australia (2005), Trends

in aged Care (2008), and

a Review of Regulatory

Burdens (2009).

“ Government has

failed to address the key short-term critical issues of this industry, those being Viability and Capital. ”

Bryan Dorman, President, ACAA

restructuring has delivered in excess of 17% in cost efficiencies based on DoHA figures for the ten years ending 30th June 2008. During this period, and after peaking in the early 2000’s, industry profitability has successively declined each year since. This efficiency has been achieved by the whole industry, forced by the inadequate COPO indexation mechanism, and not just industry high achievers!

From recent financial viability surveys and analysis by numerous independent bodies, it is patently clear to the Industry that the workforce cost efficiency drive can no longer be sustained. ACAA believes this fact is well known to all industry observers, inside and outside of Government and that this factor remains a significant disincentive to invest in Aged Care. An adequate return on capital invested by all Providers is essential for industry viability.

Under the current Capital model, Aged Care Resident Bonds are the major supplier of capital for new and replacement Residential Aged Care, except in High Care. Government argues that an accommodation allowance of $26.88 per resident per day maximum, is sufficient to meet average construction costs. The reality is, that under the current, highly regulated capital structure, this funding stream will fail to provide sufficient capital over the next 10 years to construct the 8000 new and 4000 replacement beds that must be built each year if we are to meet demand.

These two key issues will remain with all of us until the Productivity Commission reports; and only when Government is prepared to address them through relaxing the reins, otherwise those reins will become a noose! n

ACAA – SA The project will provide a multi-disciplinary approach to the wellbeing of aged care staff, involving confidential physiotherapy and psychological assessments, exercise sessions, manual handling training and workshops to educate management and staff in wellness theory and practice.

Staff will receive confidential, off-site, support and counselling for any emotional or related issues with which they need assistance.

The emphasis will be on injury prevention, however where injuries do occur, early intervention, employing an injury management action plan will take place.

In the aged care sector in SA, physical injuries comprise 77% of all claims to the workers compensation system, with an average claim cost of $29,590, a cost borne by the industry through its Workcover levies and penalties. Although the proportion of claims for psychological injuries is only 8%, the average cost for these claims is much higher, at nearly $39,000.

There is a considerable body of evidence linking the occurrence of physical injuries, their severity and the time taken to recover, to emotional as well as physical factors. In particular, research has shown that physical injury rates, and return-to-work length are strongly related to psychosocial factors within the workplace.

The term “psychological safety climate” is used to describe the policies and procedures put in place by management which are concerned with the emotional, as well as the physical health and safety of their workers.

So, the first aim of this project will be to develop and implement a process of physical and psychological interventions, which will help prevent injuries in the first instance, and reduce return-to-work times when they do occur.

The second aim will be to measure effects of this programme and verify the financial and other benefits to employers of adopting this approach in their workplaces.

A sample of aged care facilities in South Australia will be selected, and research staff from the University of South Australia will survey the sites to establish baseline data including, incidence and cost of injuries, return-to-work times, staff turnover, absenteeism, and cost of agency staff as a percentage of payroll.

Confidential surveys of staff will establish the nature of the psychological safety climate in each workplace.

By controlling the timing and type of interventions provided, the researchers will measure the relative effect of physiotherapy, and psychology interventions only, a combination of both, and no interventions at all.

The results and the methods of the programme will be fully-documented and promoted to the industry as a whole. Obviously, we hope to demonstrate a strong case for providers to adopt such a programme in their own workplaces.

The programme has the potential to produce results far beyond the simple cost-benefit of reduced workers compensation claims, although that alone should justify its adoption. We hope it will also demonstrate that looking after your staff results in happier, healthier workers, which, in turn, produces greater workplace productivity. n

In my last report I wrote about an occupational

health and safety programme for which our

Association was seeking funding from the workers

compensation claims manager in South Australia,

Employers Mutual Limited. I’m pleased to say that

we have been successful in this application, with an

amount of $200,000 being granted for our project.

t his is a project we believe has the potential to make a real difference to the health and well-being of the people who work in aged care, and a real difference to the productivity of

their workplaces.

national update

Paul Carberry, CEO ACAA - SA

8 | Winter 2010 | aca Aged Care Australia

ACAA – nSW It was uplifting to see the significant improvement across the industry in accreditation compliance when Mark Brandon, CEO Aged Care Standards and Accreditation Agency reported an increase in reaching compliance to the 44 outcomes from 63.5% in 2000 to 94.2% in 2009.

Mark also highlighted the factors from Round 4 Accreditation in identifying the risk creators that could pose problems of compliance.

Change in ownership,•Changes in systems and processes,•Loss of key staff,•Building programs and projects, and •Change in resident mix.•

The Congress was also an opportunity to celebrate the winners of the Positive Living in Aged Care awards a collaborative initiative between NSW Health, ACAA-NSW and ACS NSW & ACT. The winners showcased their initiatives to promote mental health and wellbeing in their facilities.

Dr Don Stammer discussed the Intergenerational Report and summarised his presentation with the fact that we’re living longer and are healthier, but we’re not preparing adequately for the ageing of the population. Government funding will become more strained than is suggested and although the 3Ps of the Intergenerational Report (population productivity and participation) are important, much more is needed!

The Congress program is designed to offer interesting presentations to a range of delegates and the nursing and clinical staff were not disappointed with excellent presentations on mediation management, ACFI funding and the role of the Nurse Practitioner. Information was updated by Mary Chiarella and Tracey Osmond in relation to national registration and continuing professional development for nurses.

Marketing and risk management were topics that were addressed in concurrent sessions from a range of people and although the congress is state based, certainly the presenters represented many of the states of Australia. Subtleties are inherent when discussing issues that cross boarders but the learning remains relevant especially in a national system such as aged care.

The congress would not have been complete without a presentation on the Fair Work legislation which gave an update of where we are up to and the issues that impact on wages, it was interesting that the release of the COPO adjustment was contained until well after the congress!

We always close the Congress with some light-hearted entertainment and Rod Young, Julienne Onley, Tracey McDonald and James Saunders stole the show with their ‘interpretation’ of ‘Thank God We’re Here’!

The Congress would never be a success without the tremendous support of Trade Exhibitors and Sponsors and the delegates that attend - a big thank you for the ongoing support! n

ACAA-nSW Congress 2010

The ACAA-NSW annual state congress was held

on May 20th and 21st with a record number of

delegates and trade exhibitors.

t he Minister for Ageing, The Hon Justine Elliot, gave an opening address reiterating the reforms announced by the Federal Government with the Commonwealth taking full

policy and funding responsibility for aged care and delivering a National Health and Hospitals Network.

In her speech, the Minister personally thanked those in attendance for their personal contributions and the contribution of your organisations to the provision of care.

The Minister announced that over the next four years, the Government will invest more than $310 million to help build the highly skilled aged care workforce that we need to continue to deliver high quality care. She stated that aged care workers are committed, dedicated and hard-working and that the government is providing more training places and financial incentives for aged care workers and nurses to undertake further training and enhance their careers.

Minister Elliot also announced that the Government has appointed an Associate Commissioner to the Productivity Commission for the aged care inquiry. Sue Macri is to assist and provide expert advice to the Commission in its deliberations, and in development of options for structural reforms.

The congress program was strengthened when Martin Laverty, CEO Catholic Health Care and Rod Young CEO Aged Care Association Australia discussed the Campaign for care of Older Australians: A collaboration seeking aged care reform; where the campaign seeks a commitment that the next government will act to implement the changes we expect to be recommended by the Productivity Commission.

national update

Kay Richards, manager, member Services ACAA - nSW

“ In her speech the Minister

personally thanked those in attendance for their contributions ”


Aged & Community Care victoriaaged care Providers are aware of all opportunities to set in place a prevention and remediation plan in the event matters of a serious nature are raised.

In order to assist members, ACCV has developed the dedicated resource - Residential Care: Managing Key Risk Indicators.

The resource is a practical guide to assist in identifying areas of potential risk to residents and organisations. The example issues featured in the Guide have implications for residents and the organisation as a whole. Considerations are provided in relation to each issue to act as a prompt for the organisation to examine their current systems and practices.

The Guide includes key risk areas associated with accreditation, non-compliance, sanctions, media, complaints, outbreaks and reportable assault.

The Residential Care: Managing Key Risk Indicators guide and the ACCV Strategic Plan 2010 - 2013 is available to ACCV members on the website at accv.com.au. n

triple launch at ACCv 2010 State CongressThe 2010 Stage Congress held by Aged & Community Care Victoria (ACCV) on 17 – 18 June 2010 saw the launch of three key Victorian initiatives. The launch of an upgraded ACCV website, the launch of the new ACCV Strategic Plan 2010 - 2013 and the launch of a new ACCV resource for members - Residential Care: Managing Key Risk Indicators.

ACCv Strategic Plan 2010 - 2013After reviewing the initial four years of operation as Aged & Community Care Victoria, the ACCV Board set in place its key Strategic Plan and objectives commencing from 1 July this year with the launch of the ACCV Strategic Plan 2010 - 2013. The Strategic Plan now aligns to the ACCV financial year and will be reviewed bi-annually by the ACCV Board.

ACCv website upgradeThe ACCV website accv.com.au recently underwent an upgrade to enhance its role as a user-friendly and up-to-date interactive site that provides ACCV Members with a single point-of-call for aged care industry information.

As well as a modern new appearance and easy to use menus, the site features important industry information from all areas of aged care including residential and community care, rural health, finance and workplace relations, as well as the latest in ACCV commentary and news.

Information is also provided on ACCV Taskforces and Committees, ACCV’s range of training and consultancy services and upcoming ACCV conferences and events, as well as a comprehensive list of ACCV business partners.

ACCV Members benefit from an extra selection of publications and resources which are only available to Members through a unique log-in. A Member Forum also allows Members to share documents, forms or tools they have designed to assist in the operation of their aged care services.

To view the upgraded website, visit accv.com.au.

ACCv Early Response ProtocolACCV has entered into an agreement with the state office of the Department of Health & Ageing (DoHA) to set in place a protocol promoting an early response by aged care Providers to matters of serious concern. ACCV and DoHA will cooperate to ensure

gerard mansour, CEO ACCv

national update

Aged Care Queensland

In my last report I suggested that 2010 might be

a big year for aged care. Certainly there was great

expectation that reform might be in the air. The year

started with the Prime Minister talking up reform. ACQI

engaged closely with our state health minister and

positioned aged care in Queensland to be part of the

debate on health reform.

W hile there are some positives from the referral by the Federal Government to the Productivity Commission requesting the development of detailed options for

restructuring the aged care system, the sense of urgency generated at the beginning of the year seems to be dissipating.

national update

Anton Kardash, CEO Aged Care Queensland

Of particular interest to ACQI and its members is the inclusion within the terms of reference a request to “examine whether the regulation of retirement specific living options, such as retirement villages, should be aligned more closely with the rest of the aged care sector, and if so how this should be achieved.” ACQI has strong unique retirement village only membership in addition to our aged care providers. While for some time we have been assisting these members to explore complimentary relationships with aged care providers, this development has potentially wide ranging implications. ACQI will be undertaking a consultation with these members as part of its submission to the Commission.

The months of April, May and June historically are conference time in Queensland. ACQI‘s Marketing and Events team have been flat out meeting the demand. The ACQI State Conference was very well received by members and the evaluations consistently scored 4 out of 5. When undertaking the analysis it was interesting to note that there were a significant number of first time attendees, reflecting we suspect the high staff turnover in the industry. Also of note was the reduction of large staff groups from single providers. Whereas in better times providers would send 5 or 10 staff, we are seeing much smaller groups.

In the first week of June, ACQI will on behalf of ACSA host the national community care conference at the Gold Coast. A very busy time for the events staff. We look forward to presenting another successful conference. n

Discover theCater Care difference.

In the lead up to the Federal Election it is crucial that all organisations representing matters of our ageing population take a cohesive approach, as we can no longer afford to operate in our own silos of individual issues and concerns if we are seeking long term workable reform for all Western Australians.

As the representative of ACAAWA in this Alliance I look forward to working with the other WA based organisations in the hope that we can effect some much needed change in our State. n

A common voice needed to raise concerns

As we are all aware Western Australia has some

‘unique circumstances’ as it has been coined,

however, this is not exclusive to residential and

community care services in our State, it also

extends to all seniors services.

I n recent times many of the social service, seniors, care and carer support organisations have met to discuss the range of issues they face and the merit of both greater understanding of one

another’s services, but also how some mutually beneficial support may be established.

As a result of open communication regarding the considerable collective concerns The Seniors Alliance has been established in WA which comprises of the lead non-government organisations:

Aged Care Association Australia WA (ACAAWA);•Aged and Community Services of WA (ACSWA);•Council on the Ageing WA (COTA WA);•Health Consumers’ Council (HCC);•Western Australia Council of Social Services (WACOSS);•Alzheimer’s Australia WA;•Carers WA; and •Advocare.•

Following some preliminary meetings and negotiation regarding the terms of reference for the Alliance, the group now meets on a regular basis to discuss the range of issues impacting upon those that are collectively represented by the involved organisations.

The Alliance representatives all agree that there are limited resources to meet the needs of older and ageing Western Australians and together we hope to raise the profile of seniors and their issues at all levels of government.

Considerable thanks must be extended to the Chair of The Seniors Alliance Ken Marston, Chief Executive of COTA who has not only spearheaded the initiative; he has committed considerable time and resources to coordinating the collective of organisations.

One of the first outcomes of the Alliance has to been to call on the State Government to give greater priority and attention to the key issues for WA’s older demographic and to aged care in our State.

national update

ACAA - WAAnne-marie Archer, CEO ACAA-WA

“ The Alliance representatives all agree

that there are limited resources to meet the needs of older and ageing Western Australians and together we hope to raise the profile of seniors and their issues at all levels of government. ”


Speaker Profiles

Andrew Klein (mC)Andrew Klein is an event host with a difference. A former corporate lawyer, Andrew brings his casual yet corporate style to proceedings. His aim is to simultaneously entertain, inform,

introduce, coordinate and communicate.

Apart from introducing the sessions and speakers in a uniquely professional yet humorous, audience-friendly way, Andrew will bring a new creativity to the way the Congress runs, creating an atmosphere where learning is easier.

Andrew Klein has over ten years of experience MC-ing and energising countless corporate and association conferences.

tony JonesOne of the ABC’s most experienced radio and television current affairs journalists, Tony Jones has reported for Four Corners, Foreign Correspondent, and other TV and radio current affairs programs.

He has collected respected awards for reports such as “Horses for Courses” on the Waterhouse racing dynasty (Walkley), “My City of Sydney” on the city’s development boom (Penguin), and “Frozen Asset” on the exploitation of Antarctica (Gold Medal, New York Film and Television Festival).

Awards – Now Open

Building AwardsThere are four awards on offer this year. They include:

New standard facility•New extra service facility•Renovated standard facility•Renovated extra service •facility

Employer of Choice AwardsThis award provides an opportunity for both employer and employees to showcase your aged care facility and to demonstrate to the broader industry what it is that makes your staff and colleagues want to work in aged care and for this aged care provider.

Submissions close 31st August 2010. Details and submission guidelines available from the Congress website at http://www.acaacongress2010.com.au/awards.htm

congress

Richard Dore Director – The Proteus Leadership Centres

Richard joined the team at Proteus as the General Manager of Training in 1999 and with him bought a wealth of knowledge and experience from previous training

and development roles – including his previous role in Aged Care.

Today Richard is a company Director of The Proteus Leadership Centres, which has a Mantra to ‘Create Great Leaders’ and he continues to play a significant role in the growth and success of the organisation.

Richard’s passion and areas of expertise are in leadership, culture and people development, whereby he assists organisations to create great workplaces, while destroying dysfunctional personalities and toxic workplaces!

His workshops are always packed with practical solutions that when implemented will produce immediate results. Inspirational, hilarious, irreverent practical and relevant are just some of the words continually used to describe a session with Richard Dore.

Social ProgramThe social program will provide delegates with plenty of time to network and have some fun. The first official social function will be the Welcome Reception in the trade exhibition on Sunday 14 November. There will be an Exhibitors’ Reception for all Congress attendees offsite on Monday 15 November, and then the Gala Dinner, the social highlight of the Congress, will be held on Tuesday 16 November – this year’s theme is La Dolce Vita – the sweet life. >

ACAA 29th Annual Congress14 – 16 November 2010 | Adelaide Convention Centre


www.acaacongress2010.com.au

General and Delegate Enquiries Conference SolutionsT: 02 – 6285 3000F: 02 – 6285 3001 E: [email protected] Trade and Sponsorship EnquiriesJane Murray, ACAAT: 08 – 9405 7171F: 08 – 9405 6585E: [email protected]

congress

trade Exhibition and Sponsorship OpportunitiesThe trade exhibition will be a key feature of the Congress and is an opportunity for organisations to promote innovative products and services directly to decision makers within the industry.

There are also a number of sponsorship opportunities for organisations who wish to gain a higher level of exposure. A sponsorship and trade exhibition brochure is available on request from Jane Murray, ACAA [email protected]

Exhibitors Listing50Plus•ACAA•Aged Care Specialists•Aqualogic•Austco Communication Systems•Australian Ageing Agenda•Australian Medicines Handbook•AutumnCare•Bond Maximiser Group•Campana (Goldcare)•CBA•CH2 (Clifford Hallam Healthcare)•Clinicall•Dataline Visual Link•DPS Publishing•Ebos Group•EnergyAction•Epicor•Guild Group•Health Industry Plan•Health Super•MPS Australia•Hesta•Hills Healthcare•Hynes Lawyers•iCare Solutions•Independence Australia•iSoft•leecareplus•LS Quality Consultants•Medicare Australia (Aged Care)•Medirest (Australia) Pty Ltd•Mercury•NEC•Paul Hartmann•Polyflor Australia•Presidential Card•QPS Benchmarking•Questek Australia•Rhima Australia•Richard Jay•Sebel Furniture•Simavita•ThomsonAdsett•Unicharm•Wellness & Lifestyles•Wentworth Furniture•Zenith Insurance Services•


How do you make a great organisation even better? e-health!

“Residential care – now it’s our turn to look after you!”

R SL LifeCare has been caring for and serving seniors since 1911. Founders William Wood and Stephen Stack

started with a simple vision – to look after and give the best care to war veterans. They now serve over 850 older Australians over 12 residential aged care sites and have over 950 staff. Since 2002, they have won no less than five Better Practice Awards. Deputy CEO Carolyn Kwok received the 2009 Ministers Award for excellence. They built state of the art Peter Cosgrove House 5 years ago and fund a Chair of Ageing to continuously conduct research via Australian Catholic University’s Professor of Ageing Tracey McDonald.

Carolyn Kwok, Deputy CEO and Debbie Hawkins, Quality Manager were asked, ‘so how do you improve the great care you already provide? How do you ensure that the elderly of our country, who fought to keep us safe, are kept safe when they are at their most

vulnerable?’ At RSL LifeCare, they found a method which supports them in achieving even greater outcomes for residents, fulfilling their motto of ‘it’s our turn to look after you’. In March 2008 they implemented the ‘leetotalcare’ e-health system.

An integrated, e-health strategy is not only what our elderly deserve, it is their right to not be put at risk of adverse, and sometimes fatal events due to a lack of accurate, congruent and easily accessible information. Knowing this simple truth, CEO Ron Thompson and the RSL LifeCare Board fully supported their e-health strategy from its initial inception and concept presentation by Quality Manager Debbie Hawkins and Deputy CEO Carolyn Kwok back in 2007. Since that time, the RSL LifeCare e-health ‘leetotalcare’ strategy has lessened the burden not only on staff and their management of risk but residents and families. All are secure in the knowledge that from the moment they enquire about a placement, they never have to repeat any information again. All information is sent to everywhere else it is

technology

needed throughout the system, instantly accessible by those who need it – no matter what building they are working from or even what part of the State, thus achieving true risk management.

Buying Hardware – on a budgetRSL’s ‘e-health’ implementation started with a review of the computers already available at each of its sites across the State. The hard-wired network available at each site was already established. There was little additional infrastructure required to ensure each site was able to use a WAN connection to the head office servers which would house the program.

Deputy CEO Carolyn Kwok says it hasn’t been an expensive exercise to ensure all staff are wired for data entry. Apart from a previously recognised necessary server upgrade and implementation of a Citrix network to link the ever increasing number of sites that RSL had started operating, only $12,000 across the 12 sites was required for the purchase of additional laptops to enhance and encourage staff ’s use of the system.

Most of the 12 sites use a combination of hard-wired and wireless computers. RSL found that laptops can be purchased cheaply and wirelessly connected at little cost. To also improve staff ’s access to the system, they set up ‘dumb terminals’ which both staff and residents could access, in sitting rooms, a dementia area cupboard and any other nook that was determined useful as a data entry point. Through the computers’ connection also to the internet, staff stated residents have been able to use the terminals for emails, communication via the internet and other such methods to maintain social contact with their family and friends.

Obtaining staff acceptanceQuality Manager Debbie stated “suggestions are now coming through from staff, asking us to add more information into the system to suit their needs.” “Staff have ownership of


the system, we can tweak the system when staff give suggestions, change the location of fields etc. – this has empowered them, they are now thinking of ways to make it work better for them.”

The news is also good for project managers of e-health implementations. Two years down the track, staff state ‘it’s the norm now’. Carolyn and Debbie both stated that user acceptance is no longer an issue. “The Staff satisfaction survey didn’t even need to ask staff this year if they felt they understood and used the system well, as there were no negative comments from any sources, only incoming suggestions. Even more and more over the past 6 months, staff have become confident to advise us on what they want in the system to further help them provide quality care!”

Education – helping new staffThey attribute their success also to their innovative staff buddy system. Deputy CEO Carolyn stated “our staff buddy system helps new staff and if anyone needs extra help, it is picked up immediately as we can read at anytime what they are writing and predict potential issues straight away. If we pick up a poorly written report, we can immediately track that and implement an instant education session with the person/s responsible so that we all benefit”.

They also have found that they don’t need to provide ongoing training for new staff as initially envisaged. “A lot of the implementation issues we predicted never occurred, it really is ‘idiot proof ’, our new staff see the confidence of our existing staff and run with it.” Carolyn reported that “when our managers start selling the system to their colleagues in other organisations, we know it is working. One of our managers who until recently worked in the acute sector, briefly worked in an organisation where they had a system that didn’t work for their staff so she was really nervous. But she has embraced it and worked wonders with it, picking it up instantly.”

Staff at RSL LifeCare are also reflective of the current Culturally and Linguistically Diverse background (CALD) profile present in the rest of the Australian community. They have also been supported well through the e-health system as they don’t need to spell/type in areas they access, as most answers are collated into drop down selections that

intuitively increase with individual resident data as it is entered. They can select common items and type in basic details.

General Practitioners have also contributed to the success of the program, although the GP’s they state who have embraced the technology best are those at their rural sites. “In the country, GPs are using the progress notes best, and writing great details. Now that they understand the security parameters and it has been proven to them that there is no risk of their name being attributed to any notation other than their own, they are no longer afraid to enter data which means staff are getting access to great information from which they can provide great care” says Carolyn.

Risk management over a multi-site organisationRSL LifeCare stated that their major risk issues are those that are common to all aged care sites across the country, medication management and weight/nutrition management. “We can now track our medication related incidents and get an update about where the matter is at, at any time. For nutrition matters, weights don’t fall off the radar – it just can’t happen anymore, as the alerts are present and tell us. So we have more instantaneous management, and when anyone investigates, all the information

is present and consistent as it has come from the same source” states Carolyn Kwok. “We can now see if there are any issues or gaps in information so we can manage staff better.”

“The ease for a multi-site organisation like ours with sites all over the State, to keep our finger on the pulse and to identify potential risks immediately is great” says Debbie Hawkins. Carolyn Kwok identified that their risk management strategy is supported “by the tagging of progress notes with ‘topics tags’ (which we can make), which helps us track through events and issues. We can also add additional information to the original progress notes, so an entire history of an issue or event is seen in one view – there’s no information missed as they are all together”.

“We can track through behaviour related incidents, determine if there is a trend, ie. A particular shift or time of day or person/s involved. By analysing all the information which is presented on the screen, we can determine resolutions faster and prevent adverse incidents” says Debbie.

Quality information avoids surprisesCarolyn also stated that “there is consistency of information, instant tracking and monitoring of issues. We avoid surprises; we can act straight away as we discover information straight away. Information


is power; we now have the ability to act powerfully.”

Regarding the integration of all systems, Debbie stated, “We have setup the system to ensure it is fully integrated into our quality system with all audits based on the program reports now, so that we can easily focus on issues we need to”. This they state has supported their monitoring of issues and effectively risk manage all areas of practice in a timely manner. “The alerts tell us everything so we can keep on top of issues. We have been able to tie our policies and procedures to our practice ie. If our policy says we must write notes every 7 days, then alerts tell us if we haven’t, this means we can truly link policy to practice.”

“When we review for example details of incidents, which are available to us at the touch of a button, and include these in the quality report, everyone is more accountable as the data comes straight from the incident information entered over the previous days or weeks or months” states Debbie.

“There is a direct link from our documentation to our quality system. We have done away with duplication – we can compare like with like and link outcomes back to where the information was originally raised and placed, all at the same time”.

Accreditation Agency visitsUsing an e-health system has also enabled the organisation to obtain any information they wish based on any topic, in an instant through simple word and tag searches, when accreditation agency assessors visit. Carolyn Kwok explained “we no longer have the fear that something might be missing or that we can’t find information to demonstrate our point, or actions taken in response to any matter. Whatever they access is legible, of quality (as we have been able to read it beforehand and ensure any matters are addressed at the time of writing), and most importantly, there are no discrepancies in the data that is present. The assessors can read and access more information in a shorter period of time, all is completely transparent, but most importantly, the information has been transparent to us in the preceding months also. ”

taking on new organisationsIn the past two years, RSL LifeCare has also been slowly acquiring the responsibility of a number of rural sites across New South Wales. Carolyn quoted that the work involved in taking on a new organisation is positively supported through the implementation of an e-health system. “When we join with another new organisation, the implementation of our system into all new sites has ensured a consistent quality approach to care across all our homes. We immediately support and work with the homes in a document controlled manner that enables instant movement of staff between our sites when they are needed, without settling in issues. Staff can walk in and help immediately as our entire system is identical everywhere”.

Supporting rural and remote homes access specialist careCarolyn also stated “if one of our satellite homes has an issue getting a specialist review of for example a wound, the wound consultant can log in and see exactly what staff are talking about. They can review the wound pictures, see the progression over time, read the details themselves and make a confident determination of the matter and resolution simply by getting access to pictures and information”. Given the requirement of older persons to access specialist support in a timely manner to prevent adverse events,

staff at RSL LifeCare state the single most positive outcome from the implementation regarding this issue is the instant direct access to relevant and detailed information by external experts.

transferring residents to acute careWith regard to the necessary transfer of accurate information across healthcare settings including acute care, to prevent adverse events, Carolyn stated, “Our documentation is now instantaneously available for an emergency transfer to hospital; we can send detailed information straight away. We can send a printed Health Record and Summary Care Plan as part of the transfer package which gives acute care staff the best opportunity to provide continuity of care. This provides them with the best picture of what the resident was like prior to hospitalisation, with even a picture of the resident so they can see exactly who they are caring for”.

ACFI validationsCarolyn also stated that one of the common fears of aged care management and staff is the ACFI validation process as it directly impacts on staffing budgets and available resources but she states now, “we don’t have downgrades, and a validation is completed in one day instead of two, reducing the impact on staff of a full ACFI validation activity. We know everything that is written about a resident at all times, so there are no surprises during a validation.”

A snapshot of 3 years ago compared to nowCarolyn Kwok has been with the organisation for 9 years, Debbie Hawkins for 10 years.

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“ When we join with

another new organisation, the implementation of our system into all new sites has ensured a consistent quality approach to care across all our homes. ”


Over this time there have been a lot of improvements and changes. Fundamentally though, implementing this e-health system has eased the care and management teams’ burden of guaranteeing effective and safe management of over 850 residents across 12 sites.

“We have now increased staff awareness of contemporary documentation and practices, there is nothing hidden from us anymore” says Carolyn. “The entire measurement of the impact of using the system hasn’t been formalised yet but we know we have improved. We know we haven’t had to increase staffing levels over the last couple of years to address the burden of documentation. We have done away with

all duplication; we would never go back to writing assessments and care plans by hand again knowing what we now know”.

A new residents point of viewAs is also common to many sites, some residents come in for respite a number of times over a period of a couple of years and at each admission require assessment and care plan details to be recorded . Carolyn states “staff never have to re-do any documentation when they arrive. They simply retrieve the resident from the unadmitted section of the program, go through their assessments from the previous visit to see if there are any changes required, update any relevant details only, then press the care plan button to get a new care plan”.

She says that what also blows new residents and families away is that “when our care manager conducts pre-admission interviews, all data is entered straight into the system as she takes a laptop connected to the program with her. This ensures that the care assessment/plan data is already there when the resident is admitted, most of the admission assessment questions are already answered and because this automatically makes the care plan, we have an instant interim care plan to review with them.”

Plans for RSL’s e-health futureBoth Debbie and Carolyn have plans regarding where to take this project next and how to utilise the system better. Their priorities are to:

link to an e-pharmacy package which •links data with their ‘leecare’ systemenhance their assessment and care plan •contents more by using the assessment picture upload system in the programinclude ‘reflective practice’ concepts •into their education system and ensure this is fundamental to care staff activities, ensuring this is also linked to their quality system

Advice for those embarking on an e-health journeyAs with any project of this type which involves the adoption of change management principles and effective leadership ie. changing from paper documented systems to computerised, RSL LifeCare have advise for anyone wishing to embark on such a journey. “Plan it first and ensure you get your staff on board at the start. Commit to it and ride over any ‘what-if ’ statements as 9 times out of 10 they don’t eventuate. The positives far outweigh the negatives if you select the product that works for you but remember to train, train, train - for all staff working at all levels. Don’t use a dual system (paper and computers), set a deadline for staff after training saying the start date is ___ and stick to it. We didn’t transfer data over prior to implementation because we knew once it was entered it would be virtually out of date. We concentrated in two key sites/areas first, made them our champions and we then utilised their skills and experiences to support others as they came on board. ”

Carolyn states “we would never go back to paper, it’s the way every industry has gone and it is where health has to go to prevent serious issues. Risk management and incident avoidance cannot be achieved without computerised, easily tracked systems. The vast majority of our staff embraced the new technology with open arms but what is great, and what has occurred now, is that RSL LifeCare has changed from a ‘why’ to a ‘why not’ culture”. n

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“ We know we haven’t

had to increase staffing levels over the last couple of years to address the burden of documentation. We have done away with all duplication... ”


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Healthcare Identifiers The right information at the right place, at the right time

By Suri RamanathanChair, Aged Care Industry IT Council

The Australian health system

can currently be considered as

one of the best in the world.

However, if it is to maintain

its reputation, it is in need of

immediate, transformational

reform. As part of the

reform process, the National

Health and Hospital Reform

Commission has indentified

that e-health has a major role

to play.

E -Health will facilitate the electronic transfer of information and thereby facilitate exchange of information by

care providers (doctors, pharmacist, nurses etc) who have received consent to access this information by the recipient of care. The concepts are open architecture and significantly create pathways that are beyond current software tools.

One of the foundation blocks of e-health is a health identifier which will identify the person, at the right place and at the right time.

To be able to do this, there must be a process by which each of the players in the Care process are linked to the care recipient. Currently, Care Providers are identified by a mixture of paper and electronic means; it is by no means linked seamlessly to ensure that information that is relied on is complete, current and increases safety and quality in patient care.

The Council of Australia Governments (COAG) has endorsed the establishment of such a process. The outcome of work, assigned to the Department of Health and Ageing and its Agency National E-Health Transition Authority (NEHTA), has resulted in the Health Identifier Service, which will assign three types of identifiers:

Individual Health Identifiers (IHI) – for 1. individuals receiving health care services.Healthcare Provider Identifiers - 2. Individual or (HPI-I) for healthcare providers and other healthcare personnel involved in providing patient care.Healthcare provider Identifier 3. – Organisation or (HPI-O) for organisations (such as hospitals, clinics or nursing homes) where healthcare is provided.

Presently the Healthcare Identifiers Bill 2010 and associated Regulations have passed

the Lower House of the Commonwealth Parliament and will be further considered by the Senate in June. As it has received bi-partisan support at the recently held Senate inquiry, it is anticipated that the Bill will pass.

Medicare Australia has already built the HI service and has assigned numbers to all who have a Medicare card. This legislation will not replace the Medicare Card. It is a back office function only. The care provider, individual accredited health professional will be assigned an HPI-I. For organisations, they will have to apply for HPI-O status. All of this, once the legislation is in place.

This is a major overhaul of the underlying infrastructure that will enable secure exchange of care recipient’s data, duly consented by that care recipient.

As Aged Care Providers, presently we have to know about this fundamental change. However, as nothing is in place yet, though imminent, we do not have anything yet that we have to do. Once the Legislation is passed, then software vendors will have to incorporate HI services, test them and obtain a compliance certificate to deploy it to Care Providers.

The Aged Care Industry IT Council (ACIITC) is championing the use of health identifiers for the Industry.

We ask that Providers seek input from your clinical software vendors as to what they have planned with respect to HI. n

“ One of the foundation

blocks of e-health is a health identifier which will identify the person, at the right place and at the right time. ”

View Aged Care Australiaonline!

Visit www.adbourne.com

and click on ‘Aged Care Australia’


Aged Care It vendors Speak OutBy Sonja Bernhardt and Caroline Lee

Leading vendors in the Aged

and Community Care industry

have banded together to

form ACIVA - the “Aged Care IT

Vendors Association”.

A key aim is to lobby the Government and Industry on key initiatives such as HI, eHealth, ACFI, Medicare,

Accreditation, Governance and Risk Management.

ACIVA executive consists of long term respected players in the space: President – Caroline Lee (leecareplus), Vice President - Bart Williams (Questek), Secretary – Mark Audley (Wecare), Treasurer - Chris Gray (iCare).

Organisations now recognise that business and care efficiencies can no longer be gained in the absence of computerisation. IT is an increasingly important underlying infrastructure and there is a growing recognition that efficiencies and risk management require close clinical monitoring achieved far more effectively and productively through software systems.

There are now more than 20 companies who build and develop IT specifically for the aged care industry, indicating that the vendor industry has now reached a size, maturity, capability and effect on aged care, community care and acute hospital bed delivery that it was recognised the time was right for action and with the active support and encouragement of the national offices of the ACSA, ACAA and the IT Council, ACIVA has been born.

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About ACIvA - Aged Care It vendors Association

ACIVA - Aged Care IT Vendors Association as an association, we will be able to bring a specialized and comprehensive perspective on the future development and use of information technology in Australian health care to the various industry forums and to government agencies and decision makers. http://aciva.groupsite.com/main/summary

Recent activities

ACIVA has been meeting with industry executives and organisations including the Aged Care Standards and Accreditation Agency Board at which President Caroline Lee conducted a short presentation on The Mature State of IT vendors in the aged care industry recently. Members are part of the Medicare working party (Peter Staples), contribute to the ACFI working party and have met with aged care association CEOs across the country.

Some members of the ACIVA group which has as its members represents:

ASC Computer Software•Autumn Care•Goldcare•Database Consultants Australia•Eclipse Computers•Ethan Group•iCare Solutions•Inerva•iSoft•leecareplus•Webstercare•NEC Australia Pty Ltd•Nunatak Systems Pty Ltd•PeoplePoint•Questek•Riteq•Simavita•TeleMedcare•I on mycare- Thoughtware•WeCare•


IBm Helps BCS Put Residents First with Cutting Edge Aged Care technology

Baptist

Community

Services

- NSW &

ACT (BCS),

a leading not-for-profit

Christian care organisation,

has become the largest aged

care provider in Australia to

deploy Vocera technology,

to help dramatically improve

communications internally

between staff and with

residents. The technology,

which has recently been

implemented by IBM at BCS

Orana Centre, a 190-bed site

in Point Clare, NSW will also

dramatically change the way

the organisation delivers

treatment to its residents.

t he solution consists of several components including a Cisco wireless computing infrastructure,

centralised server infrastructure, a new Internet Protocol (IP) telephony solution from Cisco that replaced the organisation’s existing telephone system and small badges from Vocera Communications that are worn around staff members’ necks on a lanyard. The solution enables staff to easily and securely call any resident’s room, and any other staff member or the front desk from any location, as well as continuing any task at hand since the solution is hands free. Residents can also use the phones in their rooms to directly contact specific staff members.

Prior to the implementation, BCS Orana Centre staff members had struggled with communications throughout the site due to its large size and vast number of black spots. With a fixed telephone system Staff were unable to work efficiently and spent a large amount of time searching for people and patients at various times throughout the day. The organisation tried using mobile phones to increase staff mobility and efficiency but this suffered due to the amount of mobile black spots throughout the site. BCS Orana Centre then turned to a radio license to enable its staff to use walkie talkies. Whilst marginally successful the units were bulky, weren’t hands free and were also affected by black spots.

In addition, the old telephony system had no voicemail so staff had to manually transfer calls throughout the site and relatives of residents were frequently frustrated because they were often unable to reach the right person on the existing two telephone lines.

BCS Orana Centre recognised technology could play an important role in addressing these communications challenges, but with no in-house IT support, it needed a

low-maintenance solution which could be easily used by non-technical staff. Working with IBM who provided the consulting, design and implementation services for the project, BCS Orana Centre identified that the Vocera communication badges would meet the facility’s specific needs. The badges, weighing less than 55 grams, use voice commands whilst on the move, allowing staff to communicate hands-free.

The facility has purchased 75 Vocera licenses to be shared across its 150 staff. Peak staff numbers hover between 35 and 48 meaning that at any stage all staff members on site will be equipped with the technology.

Introducing the Vocera communication badges means Staff no longer need to carry around bulky walkie-talkies, pagers or mobile phones. The new solution has transformed how staff and residents communicate, and has directly improved patient care by allowing staff to be more efficient and responsive to patient needs, whilst allowing

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them to spend much more time with each patient, a critical part of aged care.

Lara McIntyre, Executive Care Manager, BCS Orana Centre said: “Once we saw the technology and understood how we could utilise it for aged care, we loved it. Our Staff have spent a lot of time over the years trying to find the right person, now there is no reason for a staff member to be unable to locate the right person immediately”.

“IBM helped us put together a business case which we then presented to the Board and our CEO who agreed to fund the project”.

“The software also allows us to track how often a particular resident is calling for assistance and also means we can easily prioritise our work loads, from making a patient a cup of tea to attending to someone immediately in need of urgent assistance”.

“One example of the benefits of the technology stems from a very common issue in aged care. When a resident falls, our policy is that a Registered Nurse (RN) is required to tend to the resident. With the Vocera solution there is no need for a staff member to leave a fallen resident whilst trying to locate a free RN – this can be done instantly and provides the resident with the best physical and mental support they need at the time.”

“Because of the way the software is developed you can layer it as you need meaning you don’t have to implement the full functionality from the outset, this level of scalability enables us to be flexible in our approach and implement what we need as and when we need it”.

Concluding, McIntyre said “IBM took the time to understand our operation and that’s reflected in the way the company provides all the maintenance and management services. We now have a solution that can really improve our communication and as a result the delivery of aged care.” n

For more information please contact Lara McIntyre of BCS Orana Centre or Andrew Barton, IBM Australia Ltd Solutions Manager for Aged Care 0409 227 866.

“ With the Vocera solution there

is no need for a staff member to leave a fallen resident whilst trying to locate a free RN ”


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Overton Lea takes charge of incontinence management

The attitude of nursing home

staff to continence is that

it takes a lot of staff time, is

disruptive to residents, the

pads are a big expense and

care plans are rarely effective

or efficient. So when aged

care provider Arcare was

approached with the offer of

a system that could reduce

the effort and cost, and

could produce individualised

continence plans that were

reliable and cost effective,

they were naturally willing to

give it a go.

I n October last year, Arcare began trialing Simavita’s SIMsystem™ at Overton Lea. Seventy of the 120 residents at

the aged care home were assessed with the new technology. Residents undergoing the 3-day continence assessment wore SIMpads®, disposable continence aids fitted with sensor strips, which were remotely monitored by a central server. The server detected key information about continence events and then alerted care staff with events requiring attention. Reports for each resident were then produced which assisted staff to develop individualised continence care plans.

According to Jo Thomson, Overton Lea’s project manager for the implementation of the new system, the toileting schedules created as a result of the SIM™ assessments were much more accurate for most of the residents who were assessed.

“Some residents were going to the toilet 8 times per day, often without urinating, so for staff it was really wasting time,” Ms Thomson says. “The SIMsystem™ has

helped our staff by creating more accurate toileting schedules for residents.”

An implementation strategy for the SIMsystem™ helped ensure a successful trial. A continuous improvement plan was completed setting out key performance indicators for the system. An information session was conducted for Arcare’s Overton Lea administrators and staff, and then residents were consulted about the process. Before the implementation got under way, residents and staff were asked about their experiences of existing continence management practices. Staff carers subsequently underwent education sessions about the operation of the SIMsystem™ before their new skills were assessed. Following the implementation, residents and staff were surveyed about their experiences of the new system of continence management.

Before the SIMsystem™ was implemented at Overton Lea, staff had difficulty encouraging some able-bodied residents to go to the toilet, but most of these residents were happy to go once the SIMsystem™ “pin-pointed” the times they should go.

“We had one resident who could go to the toilet with assistance, but he never wanted to go. He had recently come to the nursing home from hospital and was miserable. After testing with the SIMsystem™ for 3 days, we discovered that he regularly voided (urinated) at 1.30pm every day. He’s a lot happier now.”

Many residents showed a significant

“ Toileting was also

improved with a reduction of 13.6

per cent in the number of checks -

equivalent to more than 20 hours

in labour per day ”

improvement in their health and wellbeing when they were reassessed and reported they felt they had their dignity back. Once staff saw that the SIMsystem™ improved resident outcomes and freed up their time they came to appreciate it too.

To measure the effectiveness of the system, staff collected the residents’ toileting schedules and pad allocations before the SIMsystem™ was implemented. They then used the SIMsystem™ to produce new assessments which led to new toileting schedules and pad allocations, ensuring better comfort for residents. These were then evaluated and refined and, based on the finalised toileting schedules and pad allocations, Arcare estimated a reduction of continence pad consumables expenditure by 23.4 per cent. Toileting was also improved with a reduction of 13.6 per cent in the number of checks - equivalent to more than 20 hours in labour per day saved as a result of more efficient schedules. These improved schedules would also lead to residents being

subjected to fewer disruptions in their daily activities and less manual handling.

As a result of the successful implementation of SIMsystem™ at Overton Lea, Arcare is applying for ‘better practice’ status as part of its accreditation, which is coming up in July.

Ms Thomson says achieving ‘better practice’ status would be like receiving a “gold star”.

“It would provide validation that we’re bringing something new into aged care. The SIMsystem™ has provided us with thorough records of residents who were assessed - graphs, cost-benefit analyses and resident outcomes.”

The evidence appears to show this new technology offers the complete package for continence care. Arcare is confident that the SIMsystem™ will make life easier for residents and staff at some of its other facilities, where the implementation process has already begun. n


Is aged and community care

your business? Do you want

to learn how your colleagues

are negotiating delivering

care in an era of high reform

and how they are enabling

and improving their services

through the smart, innovative

application of e-health?

t he ITAC 2010 organising committee invites you to participate at the 4th Annual Information Technology

in Aged Care Conference to be held 26 and 27 July 2010 at the Sofitel Melbourne on Collins. The theme of the conference, Smart Aged Care – the E-Health Revolution, emphasises the importance of information technology in establishing a sustainable, quality focused aged care environment.

The conference brings together local and international experts across the fields of community care, medication management, gerontechnology, social media and offsite information systems delivery. ITAC 2010 will provide key content and opportunities for individuals and organisations with an interest in the aged care sector. International and national experts will present on a range of topics related to the conference theme.

Presentations will also focus on the broad business and strategic issues facing an industry dealing with multiple challenges in an environment of substantial reform.

The ITAC 2010 theme of Smart Aged Care – the E-Health Revolution incorporates the following information streams:

National Health Reform and the 1. National Broadband NetworkSocial Media – The Language of the 2. Future Cloud Computing3. Electronic Medication Management4. Infrastructure – The Future of Software 5. DeliveryHardware - Getting IT Right6. E-Therapy and Fun Technology7. Community Care & Care In the Home8. Information, Documentation and 9. Workflow

These, amongst other, critical aged care topics will be discussed from a practical perspective, highlighting the information we need to know now to better manage and design aged care service delivery.

The ITAC program will stimulate, educate and inform. With the associated ITAC Awards program and social events, ITAC 2010 is the place to be – to learn, share, network with your industry colleagues and ensure you remain abreast of recent developments in the field.

For further information see www.itac2010.com.au

KEYnOtE SPEAKERS

glenn Wightwick Glenn Wightwick is Director of the IBM Australia Development Laboratory and the Chief Technologist for IBM Australia/New Zealand. In this capacity he leads a regional team of 650 software engineers and technical specialists engaged in the development and support of IBM software, and provides technical leadership across IBM’s business in Australia and New Zealand. He has led numerous systems and software development projects, and has undertaken many international assignments, including major programs of work in the US and China.

Glenn is an IBM Distinguished Engineer, a member of the IBM Academy of Technology and the IBM Corporate Technical Leadership Team. He is a senior member of the IEEE, and has served a three year term on the Australian Research Council College of Experts. He was recently appointed and Honorary Professorial Fellow at the University of Melbourne and an Adjunct Professor at the University of Technology Sydney.

Adam Powick Adam Powick is the national leader of Deloitte’s technology consulting practice and has over 20 years IT consulting experience in Australia, the U.S. and Asia. Adam was the lead author of the Australian National eHealth Strategy which was endorsed by health ministers in December 2008. Adam has been involved in the development of eHealth strategies for Victoria, Queensland and Tasmania and has worked extensively for the national eHealth agency, NEHTA. Adam is widely recognised as one of the leading authorities on the Australian eHealth agenda and is currently providing strategic eHealth advice to a range of public and private health sector organisations across Australia.

Professional Experience:

Currently assisting the Australian federal •government with the development of a business case for the introduction of a national electronic health record for all Australians. This work involves defining the implementation strategy and quantifying the costs and benefits associated with a multibillion dollar investment.

ItAC 2010 Smart Aged Care – the eHealth Revolution26 & 27 July | Sofitel Melbourne on Collins

ITAC 2010

ITAC 2010

Led the development of the National •eHealth Strategy on behalf of Australian governments in 2008 and has been heavily involved in the eHealth strategies for many Australian states and territoriesLed the development of an eHealth go •to market strategy for Telstra, Australia’s largest telecommunications companyLed the development of a electronic •health record strategy for the Australian health insurance sector representing approximately 10 million membersLed a wide range of strategy engagements •for Australia’s national eHealth entity, NEHTA, covering areas such as organisation strategy, electronic health records, ePrescribing, secure messaging and health sector stakeholder engagement

EXHIBItORSAlchemy Technology•APN Aged Care INsite•Aurion Corporation•Australian Ageing Agenda•Autumn Care•

Campana Systems - Goldcare•Clipsal - Vieo Aged Care•Database Consultants Australia (DCA)•Epicor (Aus) Pty Ltd•Frontier Software Pty Ltd•GrandCare Systems Pty Ltd•Healthsolve•ICare Solutions•ICON Global•Intel Australia Digital Health Group•iSOFT•IT:Informer•Karndean International Pty Ltd•leecareplus ®•Locating Technologies Pty Ltd•Magic Group Pty Ltd•Management Advantage•Medicare Australia•Mercury•Motion Computing•Multitone Communications Australia•NEC Australia•Nehta – National E-Health Transition •AuthorityNeller Pty Ltd•PeoplePoint Software Pty Ltd•

Procura•Questek Australia Pty Ltd•Raisoft Australia•Riverbed Technology•Simavita•TechnologyOne•TeleMedCare Pty Ltd•ThoughtWare•Universal Care Management Group•WeCare (Australia) Pty Ltd•Wellness & Lifestyles Australia•

FOR FuRtHER InFORmAtIOn:

ITAC 2010 Conference OfficeHealth Informatics Society of Australia (HISA Ltd)413 Lygon Street East Brunswick Vic 3057T: 03 9388 0555 F: 03 9388 2086E: [email protected]

www.itac2010.com.au


E-Health that Just WorksBy greg Russell

Last October I was in the USA

to enjoy both a holiday with

my wife, and to attend the

CIO Pocket MBA at Boston

University. While away I was

able to use my bank card in

the ATMs of various banks as

though I was just around the

corner from my bank here in

Sydney; and my credit card to

pay for goods and services just

about anywhere.

t his interconnectedness in the Banking industry is something we take for granted these days. In return for a very

nice fee (that’s another story!) I have most of the convenience overseas or interstate I have at home. It just works.

It’s a similar scene with airline travel. From home I can make reservations across a range of airlines either utilising my favourite travel agent or directly with the airlines. It’s pretty much all connected… and it just works. Ditto for telecommunications.

Now, let us have a look at Health Care. Whether you visit your GP, get a prescription filled at a Pharmacist, go for a Pathology test, get admitted to a Hospital, or arrange for your parents to receive Aged Care you would imagine that in this day and age, you’d have the same experience, the same interconnectedness, as when conducting financial transactions or making airline reservations.

Of course you don’t.

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In Banking, Airlines and Telecommunications common identification methods, worldwide, make a lot of things possible.

In Healthcare, the use of your Medicare Number alone does not allow the aggregation of your health records (you may have more than one). Further, there is no method to consistently and uniquely identify health care professionals (doctors, pharmacists, nursing staffing and so on).

The end result is that the primary ways of moving information around the system are “snail mail” and the fax machine.

We don’t suffer just in the area of convenience, either.

No.

Take a look at Medication. In between prescribing and administering drugs things can, and do, go wrong. The inability to access up to date patient records and the time taken to collect and collate information contribute to the preventable hospitalisation of many people each year, and to people dying. Much of this is preventable.

There are also colossal costs in moving this mountain of paper around the Health Care system as well. The National E-Health Transition Authority (NEHTA) estimates medication prescribing errors alone are estimated to cost $380m per year in the public hospital system.

So, what’s to become of this situation?

Well, the aforementioned NEHTA has been working for some years planning the progression of e-health in Australia and a significant milestone should shortly be achieved.

The Healthcare Identifiers Bill 2010 has been introduced to the Australian Parliament. The Bill proposes that each Australian will be issued a unique Healthcare Identifier, and that Health Care professionals and organisations be similarly issued unique identifiers. The objective is to enable the

consistent identification of consumers and healthcare providers and in so doing put in place a basic building block that will enable the creation and linking of electronic health care records, on a national basis.

Australia is some distance behind other countries, especially those in Europe, and while there is some frustration in this at least we can look to their experiences for lessons in what works well, and what to avoid.

The Minister for Health and Ageing, Nicola Roxon, in her explanatory memorandum to the HealthCare Identifiers Bill cites the experiences overseas in automating referrals, prescriptions and image processing between care providers, GPS and pharmacists. For example:

“E-prescription implementations in •Sweden, Boston and Denmark reduce provider costs and save time to improve productivity per prescription by over 50%

E-referrals in Denmark reduce the •average time on referrals by 97% by providing more effective access to patient information for clinicians

Test ordering and results management •systems reduce time spent by physicians chasing up test results by over 70% in implementations in America and France.”

Australia’s National E-Health Strategy (2008) outlines solutions for various components of ehealth and suggests a reduction in Health costs of $2.8 billion in net present value over ten years.

More importantly, lives, quite a few lives, will be saved.

Now NEHTA and everyone involved in Health Care realise it will take many years for e-health solutions to be developed, and for these benefits to accrue.

To assist in planning for this future NEHTA have developed a “Model Healthcare Community” in the foyer of Medicare’s Canberra office. >


< Opened in December 2009, the Community has been viewed by over 400 key members of the Healthcare are sector and is a deeper dive into future Healthcare.

The issuing by Medicare of the Healthcare Identifiers is explained and expanded upon.

Scenarios involving:E-Health General Practice •E-Health Hospital•E-Health Pharmacy and•E-Health Other Healthcare Providers•

are explored with current situations analysed, solutions proposed and benefits articulated.

Throughout all the Model Healthcare Community, and indeed in the Healthcare Identifiers Bill itself, the issues of information security and privacy are directly addressed.

There are both provisions to allow ordinary Australians to find out who has been accessing their Healthcare Identifiers, and

penalties (including up to two years in gaol) for those misusing that information.

While the Healthcare Identifiers Bill is yet to be enacted work is beginning in the Health eco-system to prepare for the e-health future. The Model Healthcare Community demonstrated prototype solutions from Best Practice (in the GP space) and iSoft from the Hospital sector.

In Aged Care, where I work, the Aged Care Industry IT Council has completed the business case for an Electronic Medication Management system intended to have relevant information available to Aged Care Facilities, Pharmacy, General Practice and Hospitals.

The diagram on this page provides a high level overview of the functionality that will be provided.

Vendor agnostic, and based on open systems it is envisaged the system will:

Reduce hospitalisation from medication •related mishapsImprove health outcomes as a whole •electronic medical record becomes availableMake it easier for Pharmacists and GPs •to do medication reviews

While NEHTA itself predicts it will be 10 years before e-health becomes “business as usual” clearly Health is going to be in for sustained, important and welcome change during that time and, who knows, one day I might just be able to access health services as easily and safely as I can my bank deposits. n

technology

Greg Russell is a highly regarded IT professional and formerly CIO in the two largest Aged Care providers in NSW. A member of both the Board of Advisors of the CIO Executive Council and the Aged Care Industry IT Council, Greg is now consulting to the Aged Care industry and can be contacted at [email protected].


Improving Aged Care through improving technology

B y 2050, nearly one-quarter of Australia’s population will be aged 65 and over, compared with 13

per cent today. Government reports have indicated there will also be a reduction in the workforce to service and support this aging population. In fact, there will be only 2.7 people of working age for every person aged 65 and over, compared with 5 people today.

The aged care industry is faced with the major challenge of improving care while reducing the cost of that care through increasing productivity, streamlining efficiencies and easing the load on staff.

The Federal Government’s Intergenerational Report 2010, states the aging population will contribute to substantial pressure on government spending over the next 40 years. Already the Government has committed $40 million on a new national IT system as part of its plan to reform management of Home and Community Care (HACC).

A factor in improving care and efficiency of aged care facilities is the sophistication of suitable information technology solutions, to allow more effective management. To maximise the reach of such technology, a new approach, known as Cloud computing has significant potential for Australian Aged care providers.

So what is Cloud computing?

The Cloud is being touted as ‘the next big thing’. Cloud computing is the provision of scalable and often virtualised resources, including software, communications and computing platforms, as a service over the internet. Cloud can offer massive savings in upfront capital costs, in-house technology labour costs and probably most importantly, time.

Until recently, only larger organisations with the infrastructure and budgets have been able to benefit from the productively gains offered by advanced IT solutions. But with Cloud,

the door has opened for smaller to medium sized aged care facilities to maximise their efficiency with access to more advanced solutions.

The biggest advantage of Cloud services is the low cost of entry and the very short setup time. Facilities have access to specialised, enterprise class software without having to cover high upfront purchase costs. Instead, the organisation pays a monthly fee per user which covers software hosting, upgrades and support. This pay-as-you-go model is usually significantly less expensive.

Only a suitable workstation, personal computer or thin client and an internet connection is required to take advantage of these new Cloud services. As such, aged care facilities can massively reduce their onsite infrastructure, power, cooling and associated purchasing, upgrade, support and maintenance costs.

By David Cooke, NEC Australia’s Group Manager, Health and Aged Care Solutions

In recent times we have seen

a far greater focus on the aged

care sector and the challenges

it faces with Australia’s

increasing population.

The aged care industry recognises that information technology can have a significant impact on improving the care of older

Australians. In 2008, the Aged Care Industry IT Council (ACIITC) was created under the auspices of the Aged Care Industry

Council (ACIC). ACIC is the peak council of Australia’s aged care providers. It brings together the two key representative bodies - ACAA and ACSA to address the issues affecting the entire industry.

The ACIITC is playing a significant role in helping the aged care sector understand how technology can benefit the industry. Suri Ramanathan, Chairman of the Aged Care Industry IT Council believes technology is a vital component to the success of Australia’s aged care industry. “We believe that many in the aged care industry will experience benefits and significant productivity gains as a direct result of a successful, appropriate technology rollout.”

NEC Australia, a provider of Cloud solutions, is working with the ACIITC to help it identify how it can enhance the IT landscape within the aged and community sector. NEC is well positioned to lend its knowledge and expertise in the Cloud solutions area – it’s one of Australia’s leading Cloud service providers. n

technology


Bill Deveney

By mike Swinson

I want to introduce you to a truly

remarkable bloke. A man who

could easily claim that he has

been dealt a raw deal by life, that

his glass is half empty. Yet this

bloke never complains about his

lot, although by my reckoning he

has every right to do so.

profile

t he fellow in question goes by the name of William Deveney or Bill as he is more commonly known.

If you are a resident of Melbourne you may remember him as a young endorsed Labor city councillor, subsequently a Lord Mayor.

‘I was elected Mayor when I was 31 years old. Our budget was bigger than some of the State Minister’s as we also operated all the city’s electricity.’

When he left council, Bill was appointed by the Labor Government as the first CEO of Victoria’s Major Events Corporation. He was married and had two children (now 3).

These days Bill is involved in aged care. He is a highly respected consultant to many organisations. You may have heard about his success in turning around the fortunes of a facility in Shepparton, or his involvement in a unique indigenous aged care project in the same town.

There are all sorts of descriptions of Bill Deveney; some say he’s stubborn, focussed, and courageous. Others say he’s thoughtful, a good listener, a man with empathy. I think he’s one of the world’s quiet achievers.

Take his activities in Shepparton as an example.

A few years ago, Bill was visiting the town to investigate the availability of land for an aged care facility when he was approached by an existing facility to ‘help them out.’ It transpired the organisation was in severe financial trouble. They had a ‘less than perfectly’ designed 30 bed building and were over a million dollars in debt.

‘It had long corridors that were boiling in summer, freezing in winter and took some residents so long to navigate that once they made it to the dining room, they would spend the rest of the day there. It was too much of an effort to have to struggle back to their rooms, particularly those residents with Parkinson’s,’ said Bill.

Now the site includes not just an aged care 67 bed facility, but also 60 two bedroom units, some that are rented out, some sold and a further 20, two bedroom ‘green’ units.

Bill says ‘the business is now in the black, all debts have been paid and it has an exciting future. Because of what I did there, the Shepparton Council asked me to give the local indigenous community organisation called Rumbalara a hand.’

At that stage Rumbalara had no land and only $3m to undertake their dreams. Over the last 2 years that has changed. What has evolved in Shepparton is unique and exciting. Construction is now underway on a $40 million multi function facility. The local ABC reported the launch of the project in this way:

“The largest capital works project in Australia, owned and operated by Aboriginal people, offering facilities catering for a broad range of ages and needs, with a particular emphasis on aboriginal aged-care.”

Bill Deveney says he is very happy to have been involved in something that will change the lives of indigenous people in and around the Shepparton area.


‘My role here is to listen, to work with the community, to work with the elders, to mentor and to facilitate. To make sure the community is getting what they want. My role is not to make decisions for them, not at all,’ he says.

‘Listening is about empathy, about understanding where people are coming from, listening from your heart and your head.’

Bill grew up as a 5th generation Australian. He lives in his grandparent’s house and he grew up in his great grandparent’s house.

According to Bill, life as a kid was hard. ‘My father was an alcoholic and manic depressive. My mother had holes in her heart and had to work fulltime to support us. All us kids had to work during school to pay for clothes and books.’

When he was 15 the family home burnt down. It wasn’t insured so the family lost everything. One of Bill’s defining memories of that time is realising that charity can be a bitter pill to swallow.

‘I can tell you that when you are the recipient of charity that is delivered for the benefit of the giver, the recipient feels like crap.’

When I met Bill Deveney, it was at an ITAC (Information Technology in Aged Care) conference. He was to be a keynote speaker, yet when I first saw him, some ten minutes or so before he was due to speak, he was lying prone on the floor of the stage. My curiosity got the better of me. I wanted to know what was going on, was this just a way of getting his mind focussed on the forthcoming presentation?

I think you will be as surprised as I was when you hear the story.

‘Life has changed a great deal for me in the last 6 years,’ he said. ‘I injured my back at a school working bee. My pain is so bad that I have a hospital bed in one board room of an organisation that I am involved with, and it’s not unusual for me to spend time at meetings prone on the floor or working from the bed.’

Bill told me that he was at a school working bee, when he picked up a plastic garbage bag that he didn’t know had been overfilled. ‘It broke and I struggled to hold it together. The result was a seriously damaged spine and sciatic nerve.’

Bill spent one and a half years in the chronic pain unit at Royal Melbourne Hospital. He’s

tried all manner of treatments, including twelve months of acupuncture. It seems nothing works.

When Bill flew to Sydney to attend the conference where I met him, he told me he was in such agony that he was in tears for over half the trip.

‘Today is a good day,’ he said. ‘I have only had 200milligrams of morphine today, plus 20 milligrams of valium.’

Bill lives with chronic pain 24 hours a day, seven days a week, fifty two weeks of the year. Think about that and imagine how you would cope, if at all.

‘My pain is sharp, it gets harder and harder, it’s a shaft of pain in my lower back and in my legs. Right now I have a shooting pain going down my leg into my foot. That’s normal, but I find I have to shut up about it, because no-one wants to hear about it.

When people ask me ‘How are you Bill?’ they don’t want to really know what I live with, how I am, so I don’t tell them.’

I do want to know about the reality of daily life for Bill, because I want a deeper understanding of how this remarkable bloke keeps doing what he does. Why doesn’t he just lie down and give up, or overdose on morphine?

Hearing about how other people cope with their lot in life is one of the things I love about journalism. It gives me a chance to be inquisitive, to share stories, to learn how people cope, what burdens they live with.

PS. Just after the conference finished, Bill ended up in hospital again as the morphine had constipated him and prevented him from urinating. During his time in the emergency ward, Doctors found that he had a solid prostate and by the beginning of the following week they discovered malignant aggressive cancer in his prostate. Bill was 51 at the time.

He has since had surgery which, would you believe, complicated his chronic back condition. However in true style, Bill was back at work a week after surgery and getting on with life.

His message to other men? ‘Keep a very close eye on your prostate, annual checks may not be enough, because things can go wrong very quickly!’ n

profile

“ Listening is

about empathy, about understanding where people are coming from, listening from your heart and your head ”

Bill Deveney (continued)


‘my Father, still driving at 100!’A profile of Percy Clayton, by Mike Swinson, told through the eyes of his only daughter Carole

How do you react when you

encounter a little old lady,

toddling along in her car,

driving much slower than

the speed limit? Or an old

bloke, who pulls out in front

of you without using his

blinker? Are you one of those

unforgiving sorts? Do you

slip into instant road rage

and rail against all “those silly

old buggers who shouldn’t

be allowed on the road?”

profile

O r do you have some empathy for older Australians who as they head past 70, 80, some even in their

nineties, who stubbornly maintain their independence and refuse to stop using the car?

I have some sympathy for them, and I can just imagine how stubborn I will be as I get older and want to maintain my freedom to travel where and when I please!

Take Percy Clayton for instance, Percy is going to turn 100 in August this year. Percy has just decided, that’s right, he decided to get a restricted license! Up till late last year he could go wherever he pleased and his daughter Carole said, he’s the sort of bloke who could quite easily hop in his car and drive to Brisbane!

‘My Dad is stubborn, stubborn, stubborn,’ says Carole. ‘He’s also the most wonderful father you could ever imagine.’

Percy grew up in an English town called Marple, near Manchester. He worked in a cotton factory. When World War Two began, he tried to enlist in the armed forces; he was fit enough, but refused because he was working in an ‘essential industry.’ So Percy did the next best thing and joined the Home Guard, or Land Army, working during the day and fire spotting at night when German Bombers came to unload their deadly cargo on nearby Manchester. His Dad was a pigeon breeder and supplied homing pigeons to the British Army.

In 1949, with his wife and three year old Carole, Percy migrated to Australia. He had been sponsored by an Australian pilot who used to stay with the family when on leave in the UK. One arrival in Sydney, Percy bought a cake shop, his wife ran the shop, he got an office job and worked in the shop after hours. He also bought a block of land and started to build a garage for the family to live in.

‘Dad was always working, doing something and he didn’t believe in borrowing money,’ said Carole. ‘He always said you don’t live beyond your means. So we ended up with two garages on the block of land, before he built the house. One garage was for us and one for his parents, who arrived in Australia not long after us. We all used to live in the first garage, five of us; till he built the second one.’

‘I’ll never forget one experience when my poor Grandmother got the fright of her life as she opened the garage door one morning,’ said Carole. ‘There, in front of her, waddling along was a big goanna. It looked huge to her; she thought it was some sort of prehistoric monster! She let out a yell and slammed the door.’

Last year they went back to England to see family and friends. ‘We did it as First Class passengers,’ said Carole. ‘I saved up all our frequent flyer points and three of us flew


< to the UK via Singapore. We broke the trip in Singapore so dad could cope with the long flights, while there we took him to Disneyland and Raffles. Then we flew to the UK and back. He had a wonderful time. He managed to cope with the long flight because in First Class you have a bed to sleep in, otherwise he would never have managed at all.’

Carole said she has never seen her father get angry or abusive. Well, only once. She

told me that her former husband used to get violent, yet she didn’t tell her father about it until after her divorce came through.

‘My ex also abused our two daughters. He came round to pick them up for an access visit once, after I had told dad about what had been going on. I have never seen my father so angry like that before.’

When my ex turned up, Dad had been gardening and he came up to him with a pick handle in his hands and said “If you ever lay a bloody hand on Carole or the kids again, I’ll take to you with this mate!”

‘Dad is five foot four inches tall; my ex is six foot two tall. Didn’t bother Dad,’ said Carole. ‘He is a wonderful man.’

Percy had a bout with bowel cancer a few years ago, and got over that. He had a minor heart attack at the end of last year and when the nurses asked him for a list of the medications he was taking he replied; ‘none and I have never had mumps or chicken pox either.’ Next question; ‘Are you allergic to anything?’

Percy’s answer, ‘yes: women!’

‘That’s my Dad’s sense of humor,’ says Carole. ‘We couldn’t do without him in this family. He has been a rock to me and the children, especially when we were going through tough times. He was a godsend to us when the girls took their father to court and won the criminal compensation case.’

‘I have only just stopped him from climbing our ladder onto the roof to clean out the gutters. I had to really put my foot down; otherwise he would still be getting up there. A neighbor rang me once to let me know that ‘the old bloke’ was up on the roof! That’s my Dad,’ says Carole proudly.

Once, when on the roof, cleaning gutters, the ladder slipped and fell. Percy was left stuck with no way down. That didn’t stop him, as he managed to jump into a nearby tree and clamber down, sporting a few scratches and bruises, but really none the worse for wear.

‘When Dad had his heart attack last year, James, my wonderful new husband, asked him how he was feeling? Dad said “I’m feeling a bit tired, I’ve got bit of a pain in my chest and I’m all clammy!” So James rang the ambulance. When it arrived, it came complete with two very attractive young female ambulance officers. James said to dad, ‘Well if you hadn’t had a heart attack before, you sure would have had one on seeing who is going to be looking after you mate!’

Percy was in hospital for four days. Once home he was back mowing lawns and doing the garden.

‘He still whipper snips the edges, mows the lawn, does all of the garden, washes and irons his own clothes. I can’t stop him, as I said he’s so stubborn,’ says Carole.

‘He still drives his great granddaughter to and from school and she loves it. We even had ‘A Current Affair’ crew film him driving the car the other day; I must admit the soundman looked a little pale and a little nervous when he got back!’

‘Dad’s a bit of a lead foot, he drives faster than he really should, but you can’t tell him to slow down!’

‘Dad sometimes says to me “I wonder why I have been allowed to live this long, is there a purpose for me still being here?” James said “Dad have you checked the paper, you might be in it!”

‘I think one of the reasons why he has lived so long is that he has always been active, he hardly ever sits still, and he feels wanted and needed. I think that knowing he is loved, wanted and needed is a critical part of why he is still here with us,’ said Carole.

‘We all love him to death.’ n

profile


guide to A Better Year End Audit Experience

Residential aged care providers are required to prepare general purpose financial statements and this means complying with all of the accounting standards. This can require a lot more work for year-end.

Work with your auditorAn audit need not be a stressful experience. Once again, the key is to be prepared. Here are a few simple steps to make the process easier:

4 Meet with your auditor well before year-end and discuss changes to the accounting standards and what effect, if any, this will have on the accounts preparation process

4 Ensure that your auditor provides you with an Audit Plan and a Year End Audit Check List (prior to year end)

4 Discuss problem areas from the previous year’s audit and ways of resolving those issues

4 Agree with your auditor the other information that will be needed in order to prepare the financial report. For example, if your organisation is a company limited by guarantee this will include some non-financial information such as:• Thenumberofmembersofthecompany• Names,qualificationsandexperienceofdirectors• Numbersofboardandcommitteemeetingsheldduring

the year and the attendance of each board member at those meetings

4 Ask your auditor whether they believe that there are any areas of particular risk and, if so, what needs to be done by the business to address that risk? For example, last year the GFC increased the risk of asset impairment and the assessment of the going concern of businesses

CommunicateThe bottom line is that the auditor should not be the only party that asks the questions in the auditor-client relationship. Open and clear lines of communication are very important. If something happens in your business that is likely to affect the year end process, or might have a significant effect on the financial statements, inform your auditor as soon as practical. On the other hand, your auditor should be keeping you up-to-date on changes that will affect the year end process, so that you can be better prepared. They should also be keeping you informed throughout the audit process. In this way all parties to the audit process will be better informed and be able to make decisions with a great deal more clarity than may currently be the case.

If you consider these issues, and implement a plan, the end of financial year audit and accounts preparation process should be easier for all concerned. n

That time of

the year is fast

approaching –

year end audit

and accounts

preparation.

This can

often be a difficult time for managers, staff and

auditors as everyone attempts to wade through

the myriad of deadlines, red tape and competing

reporting requirements.

t his increased workload often takes people away from their normal duties. The good news is that this year end process need not be so difficult. Getting a business audit ready is also

an opportunity to improve your business processes. If a business has accounts that are prepared, and audit ready, it is a sign that management is well organised and has good internal processes.

Be PreparedOne of the keys to having a smooth year end process is to be prepared. A year end will always entail more work than a normal month end. However, if the proper processes are in place, the additional workload will be on the reporting side rather than on the accounting side. Here are 5 tips to make year-end easier from an accounting viewpoint.

4 Reconcile major accounts monthly4 Prepare a good accounts working paper file and keep this file up-

to-date 4 Review your chart of accounts4 Update your fixed asset register regularly and post depreciation

monthly4 Ensure that your bond, loan and investment registers are

up-to-date

finance

Prepared by Stuart Hutcheon, Audit Partner, Stewart Brown & Co.


When Date of Entry isn’t Date of EntryBill Bourne Manager, Financial Services , ACAA-NSW

Have you noticed that the

asset assessment for some

couples does not include the

family house and therefore

you cannot charge an

accommodation payment?

W e now understand that the administrative booklet Request for Asset Assessment states that

if the asset assessment is done prior to entry their assets will be assessed at the time of the assessment and not the date of admission.

The department goes to great lengths to explain that the rule regarding accommodation payments, Accommodation Bonds or Accommodation Charges, depends on the residents’ assets at the time of the residents’ entry to care. This has been put forward by the department on many occasions:

Residents re-entering care after first •admission being pre 1 July 2004;Residents wishing to pay a higher •accommodation bond; andResidents already in aged care and wishing •to access an Extra Service place.

These are just some of many instances trotted out ad nauseum by the department to “protect the resident”.

The Aged Care Act 1997 differs from the administrative advice given by Centrelink in its advice to the public on assets assessment. The Aged Care Act 1997 states that the accommodation bond or charge must be based on the resident’s assets at the time of entry, the administrative booklet states that it

is the date of entry if done after entry and the date of assessment if done prior to entry.

In most cases there will be no difference, but in the case of couples this could mean a large difference. The effect is not only for the provider but can also affect the outcome for the resident as well.

The following article has been prepared by Rachel Lane, a Financial Advisor with Colonial First State who is one of the leading Financial Advisors in aged care.

Assets Assessment – It’s all in the timing!

Rachel Lane, Financial Advisor, Colonial First State

The Request for Assets Assessment Booklet (the Blue Book) is used to determine the assessable assets of an aged care resident for the purpose of determining the maximum amount of accommodation bond or accommodation charge payable. The information booklet that comes with the Blue Book has a section titled The timing of your assets assessment which explains that if a resident completes the asset assessment prior to entry, their assets will be assessed at the time the assessment is undertaken. If the resident completes the assessment after they enter care then their assets will be assessed as at the date of permanent entry.

The timing of an asset assessment can create very different outcomes when dealing with a couple. A couple who both enter care on the same day and submit to the asset assessment after they enter will each have 50% of the value of the former home assessed in their assets. A couple who enter care on separate days and submit their assets assessment after entry to care will have the value of the home exempted from the first to enter and half assessed against the second. A couple who both complete the assets assessment prior

to entering care will both declare that the spouse lives in the home, thereby exempting the home from each in the assets assessment.

This has been confirmed with the Department, who state:

“An assets assessment provides a snap shot of a person’s assets at the time they fill out the form. This may be prior to care or after entry. Where the assets assessments are completed prior to entry, both members of a couple will indicate in Section A Personal Details that a spouse or partner is living in the home with them and this will lead to the home being protected for both members of a couple. If the assets assessments are completed after entry then they would say that no one else is in the home. If one is done before entry and one after entry then the home will be protected for one member but not the other.

The legislation in regard to assessing assets is in Section 44 of the Aged Care Act 1997, particularly 44-8AB and 44-10. Aged care legislation does not specify when an assessment has to take place although it does have an expiry date on it. If the resident does not enter while the assessment is current they will have to apply for a new one and at that point in time their financial circumstances may have altered”.

Assets assessments for people who have not yet entered permanent care are valid for up to 4 months.

The implications of this, for both the resident and the facility, need to be considered on an individual basis.

The following case study highlights some of the tips and traps that can be associated with the timing of assets assessments.

continued next page >

Case Study Frank and Jean (Frank High Care, Jean Low Care)

House $700,000 Cash $50,000 Contents $5,000

If Frank and Jean complete the assets assessment while both are still living in the home (or while one is on respite), Frank will not be liable to pay an accommodation charge and Jean cannot be asked to pay an accommodation bond.

Assessable assets:

Home $0 Shared Cash/Contents $55,000/2 $27,500 each.

Therefore this is less than the minimum asset of $37,500 each.

The aged care facility will receive full supported resident supplement for each. Scenario 1 If Frank and Jean entered on separate days.

Frank entering first and Jean entering second, with Jean’s assets assessment after Frank’s entry; Jean could be asked to pay a maximum

accommodation bond of $340,000 while Frank would be a Fully Supported resident.

Jean’s Assessable Assets:Home $700,000/2 $350,000 Shared Cash/Contents $55,000/2 $ 27,500 $377,500Less minimum asset $ 37,500Maximum accommodation bond $340,000

Scenario 2 If Jean entered first, Frank enters second (reverse of the above) Frank would be liable to pay the accommodation charge while Jean would be a Fully Supported resident.

Frank’s Assessable Assets:Home $700,000/2 $350,000 Shared Cash/Contents $55,000/2 $ 27,500Less minimum asset $ 37,500 $340,000

Resulting in a $26.88 accommodation charge per day.

If Frank and Jean both enter care on the same day and complete the assets assessment after entry, both would be assessed as having $340,000 of assessable assets and Jean could be asked to pay a bond up to $340,000 and Frank would be liable to pay the accommodation charge at $26.88 per day.

finance

LEttERS tO tHE EDItORAged Care Association Australia is interested to hear from you. Maybe you’d like to respond to an article you’ve read or you have an article you’d like to submit.

ACAA welcomes letters to the editor of no more than 300 words. All letters must have the writer’s name, address, telephone number and job title clearly written. ACAA reserve the right to edit for reasons of space and clarity.

Send to: [email protected] or PO Box 335 Curtin ACT 2605.

It is important to be aware that if Frank doesn’t pay an accommodation charge and Jean doesn’t pay an accommodation bond they will not meet the criteria to keep and rent the former home with the asset and income exemptions that can apply. If they decide to rent the home at a future point in time, the home will be assessed for determining pension entitlement and the income will be assessed for the calculation of pension entitlement and income tested fees. If they sell the home, the proceeds from the sale of the home will be a financial asset which is subject to asset assessment and deemed to earn income.

If they leave the home empty, the exemption of the former home will expire after two years, provided that it is not rented during that time.

After the expiry of the exemption period, Frank and Jean will have their pension reduced to $841.95 per fortnight / $21,890.70 per annum combined, while the cost of care will remain the same at $38,025.70 per annum. Allowing $50 per week each for out of pocket expenses (chocolate, haircuts, outings and medication) Frank and Jean will have an income short fall of $18,390.70 per annum.

In the event that one predeceases the other, the survivor’s pension entitlement would be reduced to $29.10 per fortnight / $756.60 per annum.

As this case study highlights, there are many and varied outcomes for Frank and Jean depending on the timing of their asset assessment that can impact on; their pension entitlement, their cost of care,

eligibility to keep and rent their former home with asset and income exemptions applying and their ability to afford care in the short and long term. Any financial strategy needs to take into consideration all of these variables as well as the impact on the aged care facility to ensure that care is affordable and accessible. n

This article is based on Colonial First State Investments Ltd’s understanding of the law as at 27 April 2010. It is general information only and should not be relied on for application to particular circumstances. Readers should seek their own advice before making any decision relating to the content of the article.


workforce

Flexibility is the KeyAny form of change involves a degree of fore

thought and a considerable amount of planning

to ensure a successful outcome.......and I am

pleased to say that these two factors have

resulted in a successful launch of the Presidential

Card Employee Benefits Program (EBP).

t he EBP is an initiative by the ACAA to assist aged care organisations with employee acquisition, retention and reward. Our new model has been carefully structured

to ensure we are able to be as flexible as possible in meeting the requirements of our prospective clients. Accordingly, we now offer several models of the Program to suit the structure of as many organisations as possible.

Organisation Funded Program to All Employees: With this option, your organisation retains ownership of the Card. If an employee leaves, their Card is retained by your organisation and may be reallocated to another employee. In some cases, where an employee is considering leaving your organisation purely for financial reasons, the loss of savings associated with the loss of their Card may outweigh the financial gain of changing jobs.

•PresidentialCardEBPCardsatanannualcostof$24.90INCLGST

Employee Funded Opt-In Program: With this option, the employee purchases the Card and therefore retains ownership of the Card. If they leave your organisation, they retain ownership of the Card. Whilst this option has no financial cost to your organisation, there is no inherent HR retention strategy.

There is, however, still kudos for your organisation in providing the Program to your employees and a $40 discount to the RRP of the Program.

•PresidentialCardEBPCardsatanannualcostof$29.90INCLGST

Some organisations choose a hybrid option, where they choose (for example) to fund the Program for all full time employees and offer an Opt-In Program to casual and part time employees. In this case, we are happy to offer a price of $24.90 INCL GST for ALL employees.

Salary Packaged Opt-In Program: With this option, employees pay for the Program on a fortnightly basis. As a result, your organisation retains ownership of the Card as the payment for the Program ceases with the cessation of their Salary Packaging. From experience, it is usually necessary to offer an upfront payment option to those employees that don’t have salary packaging.

•PresidentialCardEBPCardsatafortnightlycostof$1.15INCLGST

volunteer Opt-In Program: For every Organisation that enrolls in the EBP, we offer you a way to reward your Volunteers with a co-branded Program…..at NO COST to the Organisation. We will provide a duplicate website accessible only by your volunteers which will let them view the Program, and decide if they wish to enroll. If they do, all they have to do is to complete a simple online form and pay by either Credit or Debit Card. We will forward them a co-branded Card direct to their address. There is nothing for your organisation to do!

Whether your Organisation has 50 or 5,000 employees, the EBP can assist in attracting, and ultimately retaining, quality employees. We believe Presidential Card can offer Aged Care organisations an additional avenue to nurture the most important asset in our industry.....your employees.

Whilst each website is co-branded with your organisation’s logo and welcome message, our generic website can be viewed using the following login details:

www.presidentialcard.com.au/acaaLOgIn: mB00003PASSWORD: ACAA

For full details, please contact me personally. n

Brad King

Manager Business Development

Presidential Card

0413 839999

[email protected]

Industry FeedbackA CAA has introduced a new and exciting section

in this magazine that allows you, our readers, to share ‘Good News’ Feedback letters from clients,

happy staff emails, it can be anything that is to do with our business, the business of caring for frail and older Australians.

ACAA would like to encourage anyone who works in the industry to submit their positive feedback received from clients and their relatives for publication in future editions of Aged Care Australia.

ACAA will be recognising the best client response at the 29th Annual Congress to be held in Adelaide on 14 – 16 November 2010.

Submissions can be emailed to [email protected]

Aged Care AustraliaWinter 2010Voice of the aged care industry

sponsors

guild Lawyers’ John Kelly appointed Acting Aged Care Commissioner

Guild Lawyers’ consultant

Adjunct Professor John Kelly

AM has been appointed Acting

Aged Care Commissioner from

1 May 2010.

t he appointment is testament to Professor Kelly’s broad experience in the health and aged care sectors and

expertise in the governance and regulation of aged care. Last year, John was made a Member of the Order of Australia for his service to the community in the areas of nursing and aged care policy development, and to healthcare management.

Guild Laywers’ Managing Principal Paul Baker commented on the appointment, “It is yet more deserved recognition of John’s significant achievements, as well as his good standing in the aged care industry. John’s appointment affirms our firm’s reputation for attracting the very best personnel in specialist areas of health and aged care law.”

The Aged Care Commissioner is a statutory appointment made under the Aged Care Act 1997. The Aged Care Commissioner can independently review the handling of complaints by the Complaints Investigation Scheme or the Aged Care Standards and Accreditation Agency Ltd. n

notes from an Architect’s Diary – Aged Care Projects Co-located vs Integrated and what is a CCRC? matthew Hutchinson Last time we looked at the briefing

experience and what it means to spend

some time asking the right questions

about vision, philosophy of care and

business drivers early. When planning

whole scale aged and retirement

communities there are other useful

questions to consider also. Is this village

going to offer a continuum of care? Is

there residential aged care on offer with

retirement living? Is the development

intended to be a co-located or an

integrated one? Will it function as a

continuous care retirement community

(CCRC)? Huh? You might be saying.

C o-located best describes developments where a residential aged care facility shares the site

in a sometimes tenuous/unconvincing relationship with a traditional retirement. It describes broadly a large number of developments in the last 10-20 years. The strength of the relationship between the two activities can vary from one of common management to one of entwined but still ultimately separate in posture.

Integrated describe facilities where the two traditionally separate activities are more likely housed under one roof or at least with very strong circulation links. There appears to be a trend developing in some states and with some providers to push more towards the integrated model where the relationship between the two activities is much closer than previous. These developments where a continuum of care is offered to a resident are often referred to as Continuous Care Retirement Communities – CCRCs. >

sponsors

We have noticed recently that when discussing proposals for integrated style developments with clients many of them have referenced the Humanitas Apartments for Life model as an aim/ideal in integrated and holistic care for the aged. The reality of creating this highly integrated ideal with one entry under one roof in the current local aged care environment seems to falter however once market advice and management and ownership models are overlaid on the proposals. In the Australian market it still seems that though the notion of continuous care through ageing in the same place (actual space) is desirable the industry is largely not ready or set up to deliver care this way. Government funded community care packages are the currently recognized vehicle for delivering care into a resident’s dwelling but at the present time these also have their limitations in availability and individual tailoring.

This movement toward integrated CCRC style developments appears to recognize the benefits of a closer

relationship between independent living and residential aged care where there is shared access to allied and medical services, some community facilities, hotel services and management. The buildings will often be designed with separate entries and designated common spaces however the necessary legal and operational lines are still ultimately drawn.

Perhaps this is an interim period where designs are recognizing the desire for a higher quality of lifestyle and independence is supported until the latest possible stage. Perhaps these are just another option available for a particular market and other more integrated models for care are waiting in the wings. Either way it is good to see that traditional boundaries are being pushed and that new and exciting opportunities in the seniors living appear to be heading this way. n

Matthew Hutchinson is a Melbourne-based Aged Care Architect and a Principal of ThomsonAdsett.

notes from an Architect’s Diary (continued)


Reduce training costs, improve learning outcomes – Online training

Since mid 2006, ACAA and

e3Learning have been working

together to deliver high quality

online training to members.

This project has been highly

successful and has helped to

make e3Learning a leading

supplier of aged care specific

online training in Australia.

Courses that are now available to the aged care sector include:

Understanding Dementia (series of 5 •courses)Manual Handling in Aged Care•Incontinence (series of 5 courses)•Wound Care (series of 3 courses)•Wound Nutrition •Falls Prevention•Food Safety (series of 2 courses)•Emergency Procedures for HealthCare •facilitiesOHS course suite (series of 12 courses)•Driver Safety•Industrial Relations (series of 6 courses)•Infection Control•Hand Hygiene•Senior First Aid and CPR•Basic Life Support•Preventing and Managing Occupational •Violence and Aggression in Health Care SettingsSafe Medication Management•Induction courses•

All courses have been developed in partnership with subject matter experts and are customisable to suit the culture and specific requirements of every organisation.

All training is delivered on a simple yet sophisticated Learning Management System that will track every click and enable organisations to report in real time on training progress.

Courses include expertly scripted content, professional audio, interactive activities and competency assessment. Courses can be delivered on their own, or in a blended scenario, that enables learners to get the theory online at their own pace and complete the practical in the traditional face to face setting. This model is being used by Eldercare in the delivery of the Manual Handling in Aged Care course.

Implementing this training in your organisation will help significantly reduce training costs, increase compliance and improve learning outcomes using proven educational methodology.

e3Learning is one of Australia’s largest custom course developers and can expertly

convert existing courses into interactive online packages.

If you are new to online training, begin by trying the free ‘Dementia – an introduction’ course available now at http://acaa.e3learning.com.au

For further information contact: [email protected] n

LearnX 2010 Award Winners

• Best Blended Learning Solution • Best Bespoke Learning Solution

e3Learning is ISO 9001:2008 Quality Certified


last few percentages points out of the price offerings, revealing a clear winner.

The process was transparent and viewed “on-line” at a scheduled time and date. The follow-up reports with the auction results were also easy to understand.

We envisage saving over $38,000 over 4 years with the results from the reverse auction platform.

We were also pleased that EnergyAction offered an Energy Monitoring Program which allows them to check our bills regularly for any anomalies or overcharging and organise an on-site visit by their Engineers to provide some insight into our sites’ energy consumption trends and identify areas where the sites may be able to reduce its energy consumption. A comprehensive written report from the Engineers is provided.

Overall, EnergyAction controlled the whole process. Whilst our involvement was minimised, the auction platform meant we were kept informed throughout the whole process and received immediate feedback. The best part was that it cost us nothing.

EnergyAction charged the winning supplier a small percentage of the contract price and we got a great result.” n

For more details on EnergyAction contact:Peter Naylor

Ph 03-9832 0855

Fax 03-8677 9633

[email protected]

www.energyaction.com.au

* This 10% average savings was calculated from the first “active” bid from an Energy Retailer at the auction to the final bid from the winning Energy Retailer (average of 17 Aged Care sites over past 5 months).

The “proven” savings range from 6% to 16.5% of the contract price that was initially offered to these 17 facilities by Energy Retailers when they went to market for a new electricity contract

PROvEn* 10% Saving of Energy Contracts via the Auction Process

EnergyAction P/L is an Energy Auction House that

trades contracts “on-line” through a reverse auction

platform. We invite all energy retailers (AGL, Origin,

TRUenergy, Country Energy, etc) to bid against each

other over a 10 minute transparent window, viewed

by the client, to win the lowest price for your

current or future electricity contracts.

We take clients to auction up to 24 months prior to their contract expiration. i.e. future contracts fixed at today’s lower rates.

Instead of you spending time hunting for the best deal for your energy requirements, we bring the market to you in an efficient and transparent Live On-Line Reverse Auction that drives prices down. You can be confident that energy retailers compete for your business on a level playing field. There are no hidden charges and all processes are accountable and this process is at NO CHARGE. We are paid our 1.5% fee from the winning retailer.

In addition, EnergyAction will be with you at all stages providing energy management advice and help over the course of the agreement. We help you manage energy usage, billing inquiries, power factor, greenhouse emissions and more.

Following are some comments from Havilah Hostel with further testimonials available from Churches of Christ Community Care and Ramsey Health.

“In September 2008 we were in the market to procure a new Energy contract for the Havilah Hostel group and were aware that EnergyAction had offered their services to Aged Care Facilities. I consequently contacted Peter Naylor from EnergyAction in Melbourne and he advised me that they have been very successful in obtaining the best possible energy rate and consolidating various contract arrangements using the reverse auction platform for other Aged Care facilities, along with a myriad of other local businesses.

The auction platform not only revealed the best retailer for Havilah Hostel needs, but also attained an even better result by squeezing the

sponsors


Heath care reform – the aged care chapterA summary of the progress of the review of the Aged Care Act 1997 (Cth)

Aged Care Association Australia

(ACAA), with the help of Julie

McStay, partner and head of

the Aged Care and Retirement

Living team at Hynes Lawyers,

are well under way with their

joint review of the Aged Care Act

1997 (Cth) (Act).

Hynes Lawyers, on behalf of ACAA prepared a survey tool which was distributed in March 2010. The

survey was distributed to approximately 900 approved providers as well as other industry stakeholders. Over 200 approved providers responded to the Survey which closed on 16 April 2010.

The results of the survey show that the Australian aged care industry does not believe that the industry can be sustained on the current funding model. The results demonstrate that there is an urgent need for reform of the Act with up to 91 per cent of respondents supporting legislative change.

Key areasThe Survey sought industry views on four key areas of the Act which providers had indentified during the consultation phase of the review process, as being in most urgent need of reform.

Those areas are:

quality of care – which covers the •accreditation process and the Complaints Investigation Scheme;

care fees, accommodation bonds and •accommodation charges;

the allocations process; and•

certification. •

ResultsThe Survey provides the data which will form the basis of a comprehensive report to be submitted jointly by ACAA and Hynes Lawyers to Government and to the Opposition in July 2010.

The results of the Survey on all of the areas listed above will be published when the report is published but a sample of the results follows:

79% of respondents say that the •distinction between high and low care places should be removed and approved providers should simply be allocated residential places.

88% of respondents state that approved •providers should be able to ask any resident who can afford to pay an accommodation bond to do so.

84% of respondents state that •accommodation bonds should not only be payable by low care residents.

84% of respondents state that approved •providers can not meet the capital expense of building new high care facilities when they are unable to negotiate the payment of an accommodation bond from residents who can afford to pay a bond.

84% of respondents say accommodation •charges provide inadequate capital funding for approved providers to build or maintain existing facilities.

90% of respondents say accommodation •charges provide inadequate cash flow for approved providers to build new facilities.

72% of respondents state that financial •incentives for approved providers to meet concessional resident occupancy targets are inadequate.

82% of respondents agree aged care •providers should be able to offer extra service equivalent hotel and accommodation services in response to market demand.

83% of respondents believe that approved •providers should be allowed to offer residents alternative fee and bond payment methods to those currently permitted under the Act.

next stepsThe report which will be published in July 2010 will provide a series of proposed reforms to the Act which are based on industry preferences as identified from the Survey results and will aim to extend the scope of the current health care reforms being considered by Government towards broadening the current aged care funding model.

The Commonwealth Government’s recent announcements in relation to proposed reforms to the health and aged care industry provide an excellent starting point for reform and Hynes Lawyers will also draft a submission to the Productivity Commission on behalf of ACAA, for the consideration by the Commission in its forthcoming inquiry into Caring for Older Australians.

Julie McStay of Hynes Lawyers who was engaged by ACAA to undertake the review of the Act and is the author of the Survey said; “The timing of this survey and ACAA’s impending report is fortuitous as it will provide the Productivity Commission with valuable data to assist with their inquiry. The results of the survey provide up-to-date and compelling evidence of the reforms the aged care industry consider are most urgently required to ensure the ongoing viability of the sector.”

“Without providing more funding flexibility to the sector, aged care providers will continue to struggle to provide services required by their clients. However, with carefully considered reform, revenue could be generated and services increased.”

“Given the rapidly ageing population, the Government must acknowledge these issues and give due consideration to industry concerns and the series of reforms proposed,” said Ms McStay.

Rod Young, Chief Executive Officer of ACAA, said “The need for reform is imperative, especially given Australia’s rapidly ageing population. In order for the sector to have the ability to construct new aged care facilities, the funding model that exists under current legislation needs to change. If changes are not made, the future viability of the sector will become untenable.”

“The overwhelming majority of aged care providers agree that the current system is financially unviable.1 We need to move towards a model that emphasises an additional contribution where there is the capacity for consumers to pay. The trade off for the consumer would be greater choice of hotel and accommodation services and how they could contribute towards this component of their service,” said Mr Young.

PKF Chartered Accountants and Business Advisers, through their Seniors Living Focus team, will contribute financial analysis to the report to demonstrate that the reforms proposed are viable for providers and affordable for residents. n

84% of respondents believe that approved providers can not meet 1. the capital expense of building new high care facilities without accommodation bonds. Over 84 per cent of respondents believe accommodation charges, provide inadequate capital to build or maintain old facilities. 74 per cent of respondents indicated that the current financial arrangements are insufficient to provide all required services to occupants in aged care facilities.

Heath care reform – the aged care chapterA summary of the progress of the review of the Aged Care Act 1997 (Cth)


ACAA Building AwardsBy mike Swinson

How many of you have anything

to do with new building

construction or renovation of

existing structures?

the process, unless properly managed, is almost guaranteed to raise stress levels, cause headaches, frustration

and unhealthy levels of anxiety to all those involved.

“I’m so bloody exhausted after building this I don’t want a future in aged care anymore as I am now ready to be admitted to my beautiful state of the art facility.”

ACAA’s New Building Award went to Brian King Gardens, part of the Anglicare Retirement Villages Organisation (ARV)

‘We had an ageing building at Castle Hill in the North Western outskirts of Sydney that had to be replaced. We wanted to create a residential environment not only as a centre of excellence, but also a facility capable of being converted at any time from low care to high care or to dementia specific,’ said Peter Paltoo from ARV.

Peter said the building has been constructed with a concrete frame that allows walls to be moved, the facility re-shaped. It has clusters of home like settings and was built for a very competitive price.

Project architects were Merrin and Cranston (P/L), aged care specialists, for whom ARV have been long term clients.

‘We have just completed a number of projects for ARV in NSW, one at Taren Point, one at Warriewood, the award winning project at Castle Hill and we are about to construct another facility in Western Sydney,’ says Dwayne Nielsen, CEO and Director of Merrin and Cranston.

building awards

Brian King Gardens

building awards

Blue Care Labrador Gardens

‘This is all about relationships, it’s about delivering care outcomes as well as great spaces to live in. I call it architecture with social responsibility,’ said Dwayne.

Environmental improvements in this project included energy efficient lighting, energy efficient air conditioning system and recycled carpets. The project boasts 238 beds, currently at 40% dementia, with the capacity to become 100% dementia specific as and when needed.

In the same category there were two organisations recognized with a special commendation. Georges Manor from the Kresner Group, (Advantaged Care) and the Blue Care Group’s Labrador Gardens.

Laurie Kresner can tell you a thing or two about negotiation skills, because he faced construction on a difficult site. I think the word ‘difficult’ is an understatement when it comes to negotiating with his local council!

This project struck a rough patch as Laurie tried to convince a sceptical council that

having a watercourse run right through the middle of the property shouldn’t preclude innovative design, with the building straddling the creek.

‘This was a very difficult site, it is long and thin with a watercourse running through the middle. The final solution for us was to raise the building to a height where a bobcat with its bucket fully extended vertically, can access that watercourse under the building! That’s to cope with the one in 1000 year flood!’ said Laurie.

The new building includes a huge water tank that collects about 5 million gallons of stormwater that is pumped back through toilets and used on the gardens. 64 solar panels have been installed for heating hot water and an ozone washing system that sterilises in cold water!

‘Don’t ask me about return on investment,’ says Laurie. ‘Don’t ask me about payback from all this, well at least not until power becomes very expensive!’

The construction of Blue Care Labrador Gardens aged care facility had a much smoother time of it.

This project received its commendation for its ingenious integration of internal and external space. The architects were Melbourne based Smith and Tracey.

Blue Care’s Labrador Gardens is a state of the art, 128 bed facility that reflects the Queensland lifestyle. Large projecting eave lines, exposed framing, awnings, corrugated sheeting and shading screens are major features of the building.

Large sliding glass doors offer access to the upper level terraces and balconies along with the large areas of glazing provide a transparency and lightness to the building which allows resident interaction across both levels.

The total project – including a 75 car below ground basement car park – was constructed for $20 million dollars by Walton Constructions. >


building awards

The other major award category was recognition of Renovation. The winner was the Regis Group’s Wentworth Manor. Mark Maller the Group’s Development Manager for NSW, SA and WA said the project could have been fraught with all sorts of difficulties, as it required rebuilding a 66 bed facility in stages while it was still occupied.

‘Our architects Smith +Tracey and our builders, Solutions 3 were wonderful. They had expertise in the aged care sector and also understood our requirements. They worked closely with me because we were re-building around and beside our residents,’ said Mark.

‘One thing I can tell you is that our residents enjoyed the extra activity, as there were builders, plumbers and electricians, all coming and going – and they knew it was all about creating their perfect home for the future. It was no mean feat because we also had to minimise disruption to our daily operations and critical service areas,’ he said.

‘One thing which was a great achievement without compromising the scope,’ said Mark,‘is that we brought this project in at $5000/bed under budget, that’s not bad in this day and age is it? Much of that saving can be attributed to the hard work of the architects, project management, procurement and our operations team.’

Wentworth Manor is now a five star 66 bed high care extra service facility. The refurbishment brings it into line with the exclusive residential area it is situated in, one of Sydney’s most prestigious suburbs - Rose Bay.

The re-building and re-furbishment included major external works including landscaping and major internal works on nurse stations, dining rooms, serveries, resident’s rooms, hallways and recreation rooms including the cinema and hairdressing salon. One can only imagine the planning and co-ordination that was needed to keep the facility operating, whilst at the same time giving the contractors a clear run.

Also in this award category was a special commendation to Miranda Aged Care Facility, a small family owned and run operation in Southern Sydney.

Its owners are Lindsay and Pam Doherty, and Pam is the author of that opening quote in this article and just in case you missed it; “I’m so bloody exhausted after building this I don’t want a future in aged care anymore as I am now ready to be admitted to my beautiful state of the art facility.”

When you hear about this project saga it’s no wonder she felt like that. Pam told me that Doherty & Associates Pty Ltd purchased the home in 1999 with a plan to knock it down and rebuild straight away.

Ah, the best laid plans of mice and men! Should that be mice, men and women!

‘The first plans were rejected by Sutherland Council and after a protracted six year battle with Council and surrounding residents, building commenced in 2006. The original architect was unable to get the DA (development application) through Council and after subsequent applications we had to employ a number of specialty consultants including Sulman Architectural Prize winner Steven Kennedy of Kennedy Associates to redesign the façade,’ said Pam.

‘Six long hard years later, these changes addressed the objections raised by both neighbours and the Council and ensured the second DA would be acceptable.’

Stephen Edwards Constructions was employed on a design and construct contract and Markam Ralph of Morrison Design became involved in the Construction plans. ‘This became an excellent partnership,’ said Pam.

‘Morrison Design were able to improve on our original plans without the need to go back to Council. Stephen Edwards Constructions gave us an excellent foreman who was able to stage the building, moving residents safely and protecting them from noise and upheaval. We kept a cash flow during the reconstruction period, even though it involved critical care service areas like the kitchen and laundry.’

Sounds like another remarkable achievement. It’s no wonder that the judges have such a tough time trying to pick winners from all the applications.

Time to celebrate achievement and excellence if you ask me. ‘Cheers everyone, I’ll drink to that!’ n

Miranda Aged Care Facility

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Falls-Related traumatic Brain Injury in Older People: Under-recognised, Under-diagnosed, Highly Fatal, Highly Preventable

nick Rushworth Executive Officer, Brain Injury Australia

While it might be common

knowledge that falls are

the leading cause of injury

hospitalisations, perhaps it’s less

well-known that falls are now also

the leading cause of traumatic

brain injury (TBI) – accounting

for 2 in every 5 TBI admissions in

Australia in 2004-2005.

this is not because more teenagers have decided to take drunken dives from balconies at 2 a.m. on

a Saturday, but because of the ageing of the population. 3,300 older people were admitted for a falls-related TBI in the same year. Overall, TBI is 10 times as common as spinal injury and produces, on average, 3 times the level of disability - because it is the brain that is injured. And those who sustain a TBI can experience a range of disabilities that will affect them not only physically but also in the way they think, feel and behave.

Brain Injury Australia has recently completed a policy paper for the Australian Government on falls-related TBI, particularly in older people. Its findings came as a revelation. Firstly, while it was no surprise that those aged 85 years and over – the fastest growing segment of Australia’s population – have the highest falls, falls injury, TBI and TBI death rates, it was shocking how high their death rates were.

Every local and international study of TBI outcomes in the “old old” demonstrates “100% mortality” – if you reach that age, fall over and land on your head, you die.

Secondly, even though fall-related injuries to the head are consistently the second most common after hip fracture, head trauma in older people is often overlooked and appropriate neurological assessment and monitoring forgotten. Such checking is vital since older people run a much greater risk of bleeding in the brain following head trauma. Add blood-thinning medications like warfarin to the mix and that risk increases dramatically.

Thirdly, Brain Injury Australia conducted a comprehensive scan of the nation’s falls prevention programs and, though rates of falls-related injuries to the head are rising while those for hip fracture are falling, brain injury/ head injury simply fails to feature. Hip fracture appears regularly. Brain Injury Australia believes that it is the responsibility of public health initiatives in injury prevention to not only cater for the information needs of this generation of older people but also look over the horizon at those coming through. Insofar as current consumers of falls prevention programs are motivated by the threat to their physical independence from hip fracture, Australia’s ageing “baby boomers” are just as likely to respond to the potential loss of mind, and changed behaviour, from a TBI. (Otherwise, why are they bothering with crosswords and sudoku?)

Lastly, and maybe I’m guilty of unfairly characterising the nation’s geriatricians; their prevailing stereotype of a falls-related TBI is someone demented – or dementing – in residential aged care. And the prevailing attitude of some of them; what’s a little TBI on top of their Alzheimer’s? It’s all just

age-related brain “failure”. In fact, while the rate of falls in residential aged care is much higher, the majority of them occur in the community, in the home. And what might be a “little” TBI for an 18 year-old will be much more than that for someone in their 80s. The research indicates that with every additional 10 years of age at injury, the odds on a poor outcome from TBI increase by 40% to 50%.

Brain Injury Australia’s (initial) ambitions are always modest – the mere mention of TBI alongside other injuries as a falls risk. Australia, like the rest of the developed world, is facing a “perfect [demographic] storm” that will likely result in increasing rates of falls-related TBI – the combined effect of policies around “active ageing” and “ageing in place” with increased life expectancy and enhanced survivability from injury (due to improvements in acute care). The United States’ Centers for Disease Control has read the writing on the wall and is currently engaged in an awareness campaign targeting TBI in “seniors”. And most falls, and falls-related TBI, are highly preventable as is “secondary” TBI from bleeding on the brain. For instance, men and women can be convinced that, at age 75 or 85, climbing a ladder to clear gutters may not be as smart as when they were 45 or 55. Residential aged care facilities and hospitals can be convinced to make “did you hit your head?” the first question asked of the fallen, from which all other assessment and management proceeds. n

editorial


Fragile Facilities: Regulatory Non-Compliance That May Lead To Sanctions

tracey mcDonald RN, PhD, MSc(Hons), BHA(UNSW), Dip.N.Ed, FRCNA [1]

Wendy Smallwood RN, BHA(UNSW) Cert.Gerontology & Rehabilitation [2]

Affiliations[1] RSL LifeCare Professor of Ageing, Australian Catholic University (ACU)

[2] Quality Made Easy-Aged Care, Residential Aged Care Advisory Services

Background

Because regulatory non-compliance is far and away the most significant risk faced by approved aged care

providers (APs), and because the follow-on consequences of non-compliance can be devastating to aged care facilities, the authors believe that information about these processes need to be known and understood by APs, their boards of management, managers and senior staff.

We refer to organisations found to be non-compliant or subjected to sanction as ‘fragile facilities’ because we do not regard them as being ‘negligent’ or ‘illegal’ or ‘bad’, rather these facilities have temporarily become less capable in meeting the demands placed on them by government, the general public or clients. As well the AP, without realising the extent of compliance problems, may have made unrealistic demands on the staff or prioritised other issues. Often despite the best intentions of all involved a Home, over many months and perhaps years, can have deteriorated in terms of its capacity to adequately meet the demands of regulation or the changing needs of residents in their

care. In this fragile state a Home will need to access expert help, and quickly, if it is to be returned to a strong and viable service.

APs can take preventive steps well before any problems arise that could result in non-compliance or sanctions. Ignorance of the law is not a defence and every provider of aged care services needs to know what is required in delivering services as well as fully understanding the range of outcomes that could result from failing to satisfy requirements. Information on providing services that comply with legislation and standards is freely available on the Department of Health and Ageing (DOHA) website: http://www.health.gov.au/ as well as on the Australian Aged Care Standards and Accreditation (The Agency) website http://www.accreditation.org.au/

What follows is an account of what is likely to occur when a fragile Home is identified; and a broad guide to the processes that could help strengthen their situation, achieve sustainable compliance and deliver safe and effective care and services.

the emergence of a fragile HomeWhile events associated with failing to comply with the 44 expected outcomes regulated under the Act may vary for each Home, the following broadly portrays the main elements involved in becoming a fragile Home, that is, being found by the Aged care Standards and Accreditation Agency to be non-compliant with the standards which can result in sanctions being applied.

Non-compliance with some of the 44 1. expected outcomes identified during an accreditation audit – site visit; support contact; or an unannounced site visit There is an interim period of 14 days

available for the AP to remedy the situation and to put forward counter arguments to the assessment of non-compliance. If this is the approach to be taken it is advisable that all aspects of the expected outcomes be reviewed and an action plan commenced as the appeal may not be accepted and valuable time will be lost.

The Agency decision-maker receives the 2. audit report and make a determination about the status of compliance or non-compliant. This can be different from the site audit when other information such as past compliance history and complaints frequency are considered.

If significant non-compliance is 3. determined, and this can vary depending on which expected outcomes are involved, DOHA can impose a sanction on the home. The sanction is discretionary and can involve requiring the appointment of a Nurse Adviser from the panel to the home for a period of six months; and/or require staff educational deficiencies to be addressed by a registered training organisation (RTO). Subsidy can be withheld for any new admissions and this is usually at the same time as the sanction for the Nurse Adviser.

If serious non-compliance is identified 4. the matter is referred by the Agency to DOHA where a decision is taken on issuing a ‘notice of non-compliance’ or allowing the Agency to deal with the issues. What ever the outcome, a timeframe for improvement (TFI) will be imposed on the AP to rectify. Under this approach APs provide an action plan to the Agency and DOHA that addresses the areas of non-compliance within a specified time and this is closely examined by Agency or DOHA officers.


editorial

Tips on timeA short three months is available for meeting a timeline for improvement (TFI) for non-compliance. The AP is not required to seek outside assistance to put forward a case for an appeal or to assist in developing a plan to remedy the non-compliance. What ever the case, the AP should advise the Peak Industry Body or seek advice as in how to proceed and must be absolutely certain of the accuracy of the information being provided by staff and assured that it is not an emotional response to a negative audit.

If the TFI is not met, following an Agency Support Contact a range of penalties can be imposed and the process starts all over again. This may include a review audit or sanctions being imposed by DOHA. Sanctions have typically been the appointment of a Nurse Adviser (NA) from the Commonwealth Nurse Advisor Panel and/or removal of government subsidy for new admissions. That is if the home was not already sanctioned.

If the non-compliance is referred to DOHA and a notice of sanction for a NA is applied then the AP has five days to put forward a name of a NA from the Panel to DOHA. Inaction can quickly eat up the time available for regaining compliance so the AP is advised to refer to the panel of Administrators / Advisors and seek the advice of their peak industry association on which NA would best suit their current circumstances.

Usually, the conditions that lead to sanctions will have been developing sometimes for 18 months, and warning signs that all was not going well may have been overlooked. For instance, where accreditation has been achieved the Agency Audit Reports may have been ignored or not carefully read. The important information can be found in the ‘Additional Information’ section contained within the report flagging concerns about certain systems. In such a situation a wise AP would respond to the additional information. If the audit comment is thought to be in error, a case needs to be made to the Agency demonstrating what systems are in place on that issue, and how their effectiveness in

meeting the standard is monitored or known. In this way the Home’s response is placed on the record for future audits. If the AP agrees with the audit comment then action needs to be taken to remedy the problem. Don’t delay. All details of the issue and responses should be recorded in the organisation’s information and quality improvement system so that evidence of actions taken to fix the problem can later be found and tracked.

Appointment of a nurse Adviser to a Home following the Sanction being imposed:If the DOHA sanction is for a NA to be appointed the AP is directed to engage an accredited NA from the Panel list of available NAs. The AP has five days to choose the NA they want, usually in consultation with the peak industry organisation such as Aged Care Association Australia, or on the advice of colleagues. If there is a notice of serious risk, the appointment will be required within 24 hours. It is important to select a NA who is capable of dealing with the situation that has led to this sanction being applied. For instance, you will want a person who is experienced in bringing non-compliance back to compliance. You may need someone who has expertise in identifying and dealing with clinical outcome issues; or someone who has a track-record for achieving sustainability in organisational systems such as information and communication or quality management. Sustainability means that the systems will continue to be effective beyond the TFI period of three months and the NA sanction period of six months.

the first 24 hours after the nurse Adviser is appointed:On the way to the fragile Home the NA will pre-read all audit information and any other relevant information where possible.

Residents and staff should be informed that the NA is coming and that they will be able to speak openly with him or her on any issue. The NA will require direct access to the board of management (if this is the AP) to report on progress in confidence. As well, written authority is needed from the AP for the NA to communicate on behalf of the Home with Agency and DOHA officers and this should be completed before his/her arrival.

On arrival the NA’s first strategy is to gain a cultural overview of the organisation. The NA will get to know the personalities involved on site and assess local situational power and political dynamics. It is important to understand the relationships between staff; staff and residents; residents and other residents; and how managers relate to staff and residents/families – and whether power or resistance cliques exist within any of these groups. Identifying the formal and informal leaders and how they operate greatly assists in assessing organisational culture.

Tips on peopleOften people who have raised issues in the past are in fact grieving about the situation, and when sanctions are applied this grief response increases. It is traumatic enough to just have non-compliance identified by the Agency. Displays of anger including intimidation, violence, rudeness; withdrawal and sullenness; depression and poor health can indicate grief. In such situations the NA must be confident in their skills and ability to manage difficult situations and people. Ideally, the behaviour of APs and managers should not be among these emotional displays.

Remember, the media will have access via the internet to reports which led to the sanction being applied or will be informed through statements made in parliament. Therefore the AP needs to have a media management strategy ready and this often means contacting their peak industry association and having them deal with reporters etc. Staff must be supported and sensitively reminded of their confidentiality responsibilities and also of the potential impact on residents of media sensationalisation of non-compliance and sanctions information. Residents are usually shattered to think that others can be so horrid to staff who have cared for them in their home, and they feel powerless to help. Long term complainants whose concerns may have been managed may now find a further avenue to revive their issues. Sensationalisation of old issues can be very damaging to the Home and all stakeholders in an environment of regulatory non-compliance and possible sanctions.


The next task is to complete a quick physical analysis of the site to identify obvious risks; occupational health and safety (OHS); security issues etc. Then a visual clinical assessment of residents is accomplished during a systematic walk around the Home. A view as to the general wellbeing of residents can be obtained for instance, by observing their responses to other people or activities underway and level of agitation; general hygiene; evidence of clinical status such as pain, hydration and skin condition on arms and legs.

At the end of the first day the NA needs to formulate a balanced judgement about the type and depth of any problems; and to get an idea of how the current situation evolved during the previous 18 months; and what the main areas of risk actually are. Therefore the AP needs to make available all documentation including past reports from the Agency; complaints referred to the commonwealth; and food safety audits – and any other pertinent reports. This information will assist the NA to see how the Home is regarded by other organisations and authorities, and whether those views are warranted.

The NA should be on 24 hour call for the first week in order to establish communication with all parties and hear their issues, much of which will remain confidential to the NA. APs or managers should not expect to be privy to confidential information given by staff to the NA. In some situations the source of problems may be the manager thus making staff, residents and families reluctant to freely express their issues with the NA who has the legal authority to deal with their organisation’s problems.

It is not the role of the NA to do the work of the organisation. Rather, they are there to analyse the situation, recommend remedial strategies and direct the organisational response. Some NAs lead by example and may demonstrate how certain tasks should be done, but this is not a requirement.

Tips on costAPs need to have familiarised themselves with the role, responsibility and accountability of the NA. Specifically they need to understand that the NA has direct responsibility and accountability

to DOHA but is engaged and paid by the AP… a fact often not fully appreciated by the AP or the stakeholders associated with the Home.

The issue of NA costs inevitably arises on the first day. The cost is determined by the extent of problems facing the Home as well as the need for onsite and 24 hour availability of the NA. Costs can increase where the efforts of the NA are undermined by either an AP or a Manager who may hide information or discourage openness among the staff and residents resulting in delayed progress towards compliance. It is very important for the AP and the staff to work with the NA to maximise the benefits of their contribution. Seeing the NA as a threat to existing positions or status impedes the speed and efficacy of the home’s response.

For the NAs intervention to be effective he or she needs to take immediate control of the Home. The AP should ensure that people are not alarmed about this situation. Meetings have to be set up within the first two weeks so that all stakeholders can meet the NA and hear what now needs to be done. DOHA and sometimes Agency officers will attend these stakeholder meetings as observers who may or may not contribute to the discussions. Importantly, the AP co-chairs these meetings with the NA and to preserve organisational integrity under these stressful conditions, the AP should be seen to be in control and cooperative.

the first week Ongoing organisational stability will depend on what is seen to occur during this first week therefore the AP and manager must appear to be in control and actively supporting the NA. A comprehensive account of all residents, family and staff with a history of having a heightened awareness of problems will help the NA to fully understand all past complaints and complainants. It might be prudent to invite them to actively participate in the remedial process. If the non-compliance pertains to care and lifestyle issues, contact with the general medical practitioner (GP) will also have to be facilitated by the AP.

The frequency of reporting on progress by the NA is negotiated with DOHA. Usually it entails a weekly/fortnightly written and verbal report, decreasing in frequency during the period of sanction provided continuous improvement is being achieved and maintained.

Frequency of NA visits is also approved by DOHA however usually the AP puts forward a proposal that includes onsite availability by the NA. By the end of the first day (week), the need for and frequency of onsite presence will be able to be established, negotiated with the AP and concluded.

Tips on mobilising supportOnce a Home has been sanctioned the AP must show willingness to engage other expertise from peak bodies (eg. industry associations, corporate experts and consultants) in order to achieve compliance within the timeframe. The involvement of Peak industry associations and a NA can be quite beneficial. As well as handling media enquiries on behalf of the Home, peak organisations can also support the AP through this very stressful situation and assist managers to understand and cooperate with strategies recommended by the NA.

If the fragile Home is part of a group of other independent residential aged care facilities (services), the AP should alert all other managers about the problems faced in their Home. In particular they need to identify the areas of concern that led to sanction and encourage other facilities to review their systems to ensure they do not face a similar risk situation.

By the end of this first week, most issues will have been identified and strategies in place to reverse the problems that led to the NA being appointed. If Home managers and staff are cooperative the following weeks and months are a time of significant change which will need to be undertaken sensitively. Residents, families and staff will have their own views on the issues and what now needs to be done, and throughout the processes of change it is important to rebuild confidence and certainty about the services and the standards being met. >

< As organisational competence increases, usually at around four months, the NA withdraws from direct involvement to ensure the Home can stand alone without returning to a fragile state as soon as NA advice ceases. Usually the three month TFI results in changes and improvements being achieved well before the NA conducts this test of Home sustainability.

It may be possible, using procedures prescribed in regulation, to renegotiate with DOHA about the timeframe for financial, management and other sanctions on a Home. Such an option relies on the NA and the AP assuring DOHA that the Home is on top

of all problems and in a position to provide evidence of ‘system sustainability’. That is, that organisational systems now operate without direct advice from the NA.

ConclusionWhen we consider what is involved with providing safe and effective aged care within the regulatory, funding and environmental constraints on the Australian aged care industry, it is not difficult to understand why there are instances of non-compliance, some based on technical details but also some sufficiently serious to attract government sanctions.

The different roles and competencies of a range of staff involved in responding to sanctions must all operate to achieve the one objective, that is, to implement whatever changes are necessary to achieve quality outcomes for residents. It is crucial that these change strategies not be undertaken without supporting all involved and

accessing the resources needed to quickly achieve compliance.

The appointment of a Nurse Adviser to this process can ensure the safety of residents and set the direction for a return to functional operations, but only if their role and responsibilities are well understood by Home stakeholders, and only if they are given the support and respect needed to perform that role.

We hope that this article provides some insights on the many matters that arise when fragile facilities need fixing. n

editorial

Acknowledgement

The authors would like to acknowledge the contribution made by Ms Helen Hill, Aged Care Adviser, Commonwealth Panel Member, Administrator & Adviser and Aged Care Standards and Accreditation Agency, External Assessor and partner in Quality Made Easy – Aged Care.

Fragile Facilities: Regulatory Non-Compliance That May Lead To Sanctions

mature FriendsBill and Sam, two elderly friends, met in the park every day to feed the pigeons, watch the squirrels and discuss world problems.

One day Bill didn’t show up. Sam didn’t think much about it and figured maybe he had a cold or something. But after Bill hadn’t shown up for a week or so, Sam really got

worried. However, since the only time they ever got together was at the park, Sam didn’t know where Bill lived, so he was unable to find out what had happened to him.

A month had passed, and Sam figured he had seen the last of Bill, but one day, Sam approached the park and — lo and behold! –there sat Bill! Sam was very excited and happy to see him and told him so. Then he said, ‘For crying out loud Bill, what in the world happened to you?’

Bill replied, ‘I have been in jail.’

‘Jail?’ cried Sam. ‘What in the world for?’

‘Well,’ Bill said, ‘you know Sue, that cute little blonde waitress at the coffee shop where I sometimes go?’

‘Yeah,’ said Sam, ‘I remember her. What about her?’

‘Well, one day she filed rape charges against me; and, at 89 years old, I was so proud that when I got into court, I pled ‘guilty’ ..

‘The damn judge gave me 30 days for perjury.’ n


Aged Care Reform – ACAA Recommendations

ACAA recommended to

Government that the Terms

of Reference include the

following items:

1. Long term FundingAustralia will shortly face a considerable intergenerational burden and impact on Commonwealth outlays unless there is some reform to the tax base, the Medicare levy or personal contributions.

ACAA recommends the Productivity Commission examine a range of long term funding issues:

A. Long term care insurance,

B. Expanding the Medicare Schedule to include a range of aged related services,

C. Health savings accounts for all Australians,

D. Increase the superannuation guarantee levy by 2% for all persons over 45 years with a percentage of funds generated by the extra contribution to be guaranteed for securing aged care health services for the over 65 year old group,

E. Examine whether a market and demand focused service would deliver greater efficiencies and better financial outcomes whilst ensuring equity of access,

F. Explore whether the Government should become an explicit purchaser of aged care services for those persons for whom it is fully responsible; whilst allowing a market driven service to develop for those clients who have some personal financial capacity.

2. Operational IncomeA. Undertake an analysis of what services

Government/Community expect aged care providers to supply and assess the cost for such provision,

B. Explore how the cost of care can be regularly reviewed to ensure future pricing reflects changing service quality and client acuity,

C. Explore an industry wide index that adequately reflects annual cost escalation in the industry,

D. Analyse the wage differential between aged care providers and the health system and explore options for developing a competitive wage base for aged care,

E. Examine whether the current care subsidy is sufficient to meet the increasing acuity status of care clients.

3. Capital IncomeA. Analyse the likely impact on residential

care providers if the aged care approvals round were to cease and assess the impact on provider balance sheets if the value of aged care licenses were reduced to cost or less as well as solutions,

B. Develop a range of options that will meet the capital needs of the industry for the next 30 years,

C. Examine the current mixed bond/charge scheme and evaluate the strengths and weaknesses of the components of the existing scheme,

D. Model the separation of care from hotel and accommodation services and explore the impact of such a charge,

E. Examine the impact of a price differential for building and accommodation types,

F. Examine other options to finance aged care capital needs eg:

i. Government funded pool,ii. Government pool which is

reimbursed from a client’s estate,iii. A contracted arrangement with

financial institutions to pay a lump sum on behalf of those with the capacity which is then reimbursed from a client’s estate,

iv. An insurance scheme for the aged care sector.

4. Equity of AccessA. Examine how small rural and remote

facilities and those providing services to lower socio economic status groups can best be supported in a system with a stronger market focus,

B. Explore what structural mechanism best meets the public policy objective of ensuring equity of access particularly for persons from socially disadvantaged backgrounds while achieving the highest levels of overall systems efficiency,

C. Examine whether removal of planning ratios and allocating places to ACATs would ensure equity of access for future clients.

5. Consumer ChoiceA. Examine how consumer choice for a

range of care services can be offered whilst ensuring overall service efficiency is not diminished,

B. Review overseas experiences with consumer directed care and advise whether these programs are achieving the intended objective and whether service quality and efficiency is being maintained.

editorial

6. Systems IntegrationA. Examine the steps the Commonwealth

Government would need to undertake to successfully re-align responsibility for the over 65 years component of the Home and Community Care program.

B. Examine the financial and service impacts of the recommendation that the Commonwealth Government restructure Aged Care Assessment Teams (ACATs) to be transferred to full Commonwealth control.

7. Community CareA. Explore the options available to

Government to ensure the highest level of service provision is delivered in the client’s home,

B. Examine how best to ensure the maintenance of quality services when delivered in the community,

C. What funding structure should in future be adopted to provide competitive neutrality between service types while ensuring maximum choice options for clients,

D. Compare the cost implications on primary and secondary health systems when a person is maintained in the community as opposed to an institutional setting.

8. Information technologyA. Examine what information technology

systems can improve care and workforce efficiency in a range of care settings,

B. Explore the deployment of assistive technologies and monitoring devices which will support persons in their domestic environment,

C. Examine funding options that will support deployment of home based technologies. n

Aged Care Reform –ACAA Recommendations


Better Oral Health in Residential Care trainingThe Better Oral Health in

Residential Care Training has

commenced and is coming

soon to a region near you.

the Nursing Home Oral and Dental Health Plan was announced by the Minister for Ageing on 1 March

2009 and is designed to strengthen dental and oral care in aged care facilities from the initial ACAT assessment through to care planning and management. The Better Oral Health in Residential Care Training is one component of the Plan.

The training has commenced and will continue throughout 2010.

Training is being provided for two registered nurses/dedicated trainers in each aged care home, multi-purpose service and Indigenous flexible care service. The training uses a train-the-trainer model so that staff can in turn train the aged care workers in their facilities in daily oral hygiene.

Facilities and aged care workers will receive practical training resources. A self-learning package of tools and further resources will also be provided to registered nurses to enable them to undertake: oral health assessment; oral health care planning; and appropriate dental referrals for residents.

It is important that the right staff attend the training. Staff attending should be aware that this is a train-the-trainer model and that they will be expected to deliver the training once they return to their workplaces.

In addition, as one part of the training will focus on the self-directed package, it is

essential that at least one of the two staff attending the training is a Registered Nurse (RN). If a facility has a dedicated trainer who is not an RN but who could very competently deliver the training, it would be appropriate to send the trainer along with an RN.

A number of Registered Training Organisations (RTOs) nationally have been selected to undertake the training. They are currently contacting homes to let them know of the training schedule. For further information about training in your area, please contact the relevant RTO, as per the table below. n

Region RTO Website Phone

ACT Health Skills Australia www.healthskills.com.au 1300 306 886

NSW - major cities & inner & outer Regional NSW

Health Skills Australia www.healthskills.com.au 1300 306 886

NSW - Remote TAFE NSW-New England www.newengland.tafensw.edu.au 02 6768 2061

Queensland Southern Queensland Institute of Technology

http://www.sqit.tafe.qld.gov.au/courses/course_areas/aged_care_oral_health_training.html

07 4694 1903

Northern Territory Health Skills Australia www.healthskills.com.au 1300 306 886

South Australia - major cities & inner & outer Regional SA

Royal District Nursing Service (RDNS)

www.rdns.org.au/education/index.php 1300 364 264

South Australia - remote and very remote

Health Skills Australia www.healthskills.com.au 1300 306 886

Tasmania Tasmanian Skills Institute www.skillsinstitute.com.au 03 6336 2764

Victoria Health Skills Australia www.healthskills.com.au 1300 306 886

Western Australia Central Institute of Technology (formerly Central TAFE)

www.central.wa.edu.au 08 9427 3725

Further information about the training is available from: http://www.health.gov.au/betteroralhealthtraining


2010 Calendar of EventsItAC 2010

Information Technology in Aged Care 2010The eHealth RevolutionContact: ITAC 2010 Conference OfficeHealth Informatics Society of Australia E: [email protected] T: 03 9388 0555F: 03 9388 2086www.itac2010.com.au

26 & 27 July

HIC 2010

HISA Health Informatics Conference 2010Informing the Business of HealthcareMelbourne Convention & Exhibition CentreE: [email protected] T: 03 9388 0555F: 03 9388 2086www.hisa.org.au/hic2010

24 – 26 August

Building On Aged Care Workforce

Recruitment & Retention Strategies to Overcome Staff ShortageCitigate Centre, SydneyCriterion ConferencesT: 1300 316 [email protected] www.agedcareworkforce.com

24 & 25 August

2010 ACSA national Conference

Explore the Possibilities Contact: Conference Design Pty LtdT: 03 6231 [email protected] www.agedcare.org.au

19 – 22 September

gP10RACgP Conference

Shaping our futureT: 03 9417 0888E: [email protected]://www.gp10.com.au

6 – 9 October

ACAA 29th Annual Congress

Ageing in Australia – evolution or revolution?Adelaide Convention CentreContact: Conference SolutionsT: 02 6285 3000E: [email protected] or [email protected] www.acaacongress2010.com.au

14 – 16 november

events

advertorial


the legacy of John Sidney’s pianoBy Carol Brett

There are times in life when

magic happens; times when

a serendipitous encounter

between two strangers alters

the normal course of events

and something truly wonderful

follows – something with the

power to touch and enrich the

lives of others and, in this case,

provide a truly special gift to

the elderly.

You could say magic happened on the day in 1998 when Graeme Pope was unwittingly captivated by the

music of Tasmanian pianist, John Sidney. A flight engineer on a stopover in Hobart, Graeme was so enthralled by John’s playing he changed all plans for the day so he could remain in the hotel where John was performing and introduce himself to the remarkable musician after the show.

In the years that followed, the two became firm friends based on a mutual love of the piano and a passion for the music of the dance-hall era when the piano was fundamental to entertainment and sing-alongs were central to family and community life.

“John’s style of playing is so unique,” Graeme says.

“It’s very much ‘family round the piano’ type of music, just as it was before television took over.”

As well as performing in Tasmania, with Graeme’s help John was also performing in Graeme’s home state of Victoria where he performed and entertained at many of the nursing homes and retirement villages in and around Melbourne.

It was a demanding schedule for both of them and it led quite naturally to the realisation they should professionally record John’s music on CD so it could reach a wider audience. So in 2000 the pair found the best recording studio in Hobart and in 12 months had immortalised John’s music in a four-volume set of CDs.

In 2002 the pair went back to the studio to record several more musical volumes. Tragically, prior to recording two Christmas CDs, John broke his wrist in a fall, which ended his career. And shortly after this, he succumbed to bone cancer.

Had it not been for that chance meeting with the aviator in 1998, John’s music might also have died. But that’s not what happened thanks to Graeme’s enduring loyalty and his promise to keep the music alive for John’s many fans and people for whom the music of John Sidney’s era has a special connection.

“Prior to meeting John, my life had been all about aviation. But this brush with the entertainment world changed my life,” Graeme said.

“I promised John I would do everything I could to keep his music alive. So after retiring from the aviation business I began producing CDs of his work because I knew I had something unique and precious that should be shared with as many people as possible.”

“The first CDs were made available to aged care facilities in Perth when I was holidaying there with our daughter and her family in 2003.”

Since then, John Sidney’s music has been championed by diversional therapists in nursing homes and aged care facilities all around Australia. The music is highly valued for the feelings of joy, relaxation and connection it engenders among the elderly, even in those with dementia.

The CDs in Graeme’s collection are like precious time capsules. They contain musical memories of a wonderful artist whose repertoire of piano classics embraces great tunes, sing-a-longs and show stoppers as well as evergreen and relaxing music that will bring back many memories for all.

To find out more about John Sidney and his music you can phone Graeme and Sandra Pope on (03) 5428 7071, or view the entire John Sidney collection and hear a sample of each tune at www.evergreenmelodies.com n


product news


B AXX is an advanced development discovered out of investigating methods of combating germ warfare by the British Ministry of Defence who had a remit to assess the

risk of bacterial attack on the British Isles in the 60/70’s. This in turn had been initiated by observations over a hundred years prior by Louis Pasteur who had documented that the atmosphere in high altitudes and sunny days reduced the incidence of infection and effectively killed bacteria and viruses.

The answer lay in the natural occurrence of airborne Hydroxyl Clusters.

Modern technology and electronics allows the BAXX to achieve the aim of eliminating airborne pathogens by using cold plasma to strip a hydrogen atom from some of the natural water molecules (H20) contained in the air around us, leaving them as unbalanced hydroxyl clusters (-OH). These clusters seek and attach to airborne bacteria and virus cells and recover their missing hydrogen atom from the cells wall to return to a natural water molecule again (H2O).

In that instant, the bacteria/virus metabolism and cell wall is disrupted and the cell dies.

Thus nature’s way of eliminating airborne pathogens has been reproduced.

Hydroxyl clusters will also land on surfaces and kill surface contamination by the same method.

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Baxx Australiawww.baxx.com.auPh: (02) 9939-4900Fx: (02) [email protected]

See ad on page 62 of this issue.

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Our enthusiastic and responsive sales team will work with you to develop a timely and affordable solution to your equipment needs. n


Icon global and Carelink+

C ontacting home carers and keeping their rosters up to date used to be an arduous process involving large roster books and client cards. These days, the process is made much simpler and considerably more efficient

using rostering software and mobile phone technology.

Icon Global are leading the way by linking sophisticated rostering technology with mobile phones. Carelink+ is a full client management system that unites rostering with client and employee management, award interpretation, exports, case management and statutory reporting. The rostering in carelink+ is easy to use and comes packed with features to make rostering simpler and more efficient.

One of these features is carelink+ mobile which allows the employee to view their roster for the week in an easy to read format on their mobile phone. The employee can look up client information, view notes, alerts and shift information. They can also start and end each visit and capture the client’s signature, automatically sending the information back to the office in real time. This helps reduce occupational health and safety risks by letting office staff know when the employee has arrived or departed from a location where there are risks present.

Roster processing time is also significantly reduced, as office staff only manage those shifts that do not fall within roster tolerances, which can be as little as ten per cent of services provided. This saves enormous time and money and allows the team to get on with the job at hand – caring for the clients.

Combined with the case management, delivered meals, community transport, interfaces and exports available in carelink+, the carelink+ mobile application can help community care organisations to keep on top of their client and employee requirements and make genuine cost reductions.

For more information, visit www.iconglobal.com.au or come and visit the exhibition at ITAC Melbourne. n



m anagement Advantage is a leader in

the Australian aged care industry with twenty years of experience providing quality software and consulting solutions.

Working together, our team of experienced software developers and specialist clinical consultants have designed Manad Plus.

Manad Plus is the most comprehensive residential aged care software product on the market today. It has been designed to ease the pressures of administration, comply with accreditation, manage care and financial risk and to optimise ACFI appraisals and care outcomes.

Features of Manad Plus include:ACFI appraisals•Person centred assessments and care plans•Progress notes•Incident reporting•Clinical indicators and charts•True B2B online claiming with Medicare•Continuous Quality Improvement plan (CQI)•Noticeboards for managers, staff and handover•Alerts and scheduling of tasks•

…plus so much more

Recently we have developed another module, Manad Plus - Bond & Billing. This will manage your accommodation bond portfolio and perform all tasks related to resident billing.

Manad Plus and Manad Plus - Bond & Billing is suitable for small 30-bed facilities or large organisations with over 1000 beds.

Contacts us on 1300 62 62 32 to learn how your organisation could benefit from one of the tailored software solutions offered by Management Advantage. n

SCRuBtEC 233 from nilfisk-ALtO

SCRUBTEC 233 represents a unique scrubber-

dryer combination of compact design, cleaning performance and drying efficiency.SCRUBTEC 233 represents a unique combination of compact design, cleaning performance and drying efficiency. However, despite its compact profile, the SCRUBTEC 233 offers the highest brush pressure within its class.

Designed to scrub and dry floors in congested and space-restricted areas, this unit is intended for use in canteens, restaurants, hotels, schools, kitchens, retail areas, garage/car facilities and anywhere that can normally only be cleaned by a single-disc machine and vacuum cleaner. The SCRUBTEC 233 features spring-activated dual brushes/pads with a floor pressure of up to 18 kg to ensure cleaning efficiency. Furthermore double squeegees enable vacuuming and scrubbing whilst moving in either direction, backwards or forwards. The machine weighs just 22 kg and can easily be transported from one job site to another.

With an additional accessory kit, SCRUBTEC 233 can also be used as carpet/upholstery cleaner for cleaning office carpets/furniture, car seats etc. For more information visit www.nilfisk-alto.com.au n

t o appreciate RAIsoft you first need some knowledge of the interRAI consortium. Established in the mid 1980’s in USA this international collaborative group of aged

care specialists came together to improve the care of older people in nursing homes – with the concept advancing into 30+ countries. Based on rigorous research and vigorous testing, assessment tools now provide the basis for care planning, quality and risk management, research, and staffing ratios. It is a proven system in many countries leading to improvements in quality of life and function, and reduced clinical symptoms in patients / clients / residents.

Commencing with a long term care (nursing home) tool, the suite of assessments has expanded to include home and community care, acute and post acute care, palliative care, mental health, and disabilities. This suite of assessments facilitates continuity and supports the concept of a universal health record for seniors no matter what their situation or place of care. As a multi-disciplinary tool there is valuable information for medical practitioners, nurses and members of the allied health profession. These features

enable innovation and electronic health care – to search, share, refer, communicate, and report.

RAIsoft specialises in turning this ‘genius’ into an easy to use and simple platform for planning and quality care. Starting with a holistic and comprehensive assessment a range of useful outputs is automatically generated such as: performance scales e.g. for cognition, ADLs, pain, depression and nutrition; assessment protocols for risks, strengths and needs plus an evidence based guide for care planning; robust quality indicators; case mix indices that identify dependency levels; variety of reports for clinicians, managers and facilities; trends and benchmarking data.

Established in Finland in 2000, RAIsoft now operates internationally providing the complete suite of InterRAI products. Local aged care experts with hands-on experience in the implementation of RAIsoft, bring a wealth of knowledge to make RAIsoft easy to use, practical and effective. The use of RAIsoft brings many demonstrated benefits such as: no duplication in data capture, accurate assessment of client / resident, a tool utilised by the multi-disciplinary team, and quality in monitoring and planning. n

Raisoft AustraliaRuth Baxter, Operations ManagerPhone: +61 (0)3 8794 9136Mobile: +61 417 753 339Email: [email protected]


product news


the Rapidly Changing Face of Aged Care – Sustainability!John BrodieVim Sustainability

As a sustainability consultant to the commercial built environment and primarily Aged Care I am pleased to see over the last two years such a change in commitment by providers towards sustainability in their facilities.

In some cases we are helping clients achieve levels of sustainability in facility design unheard of even three years ago and in many cases these levels of sustainable design are superior to design initiatives

being implemented in similar facilities overseas.

Who could ever imagine an aged care facility having a performance target of Zero Emissions back in 2007? Well imagination can tend to become reality very quickly!

Many clients are now gaining a feeling for the value of saving resources, especially coal fired electricity and how the rapidly rising cost of electricity is going to impact on their future operations and their financial bottom line. Not to mention the cost to the climate and our world.

In addition many clients are slowly moving towards minimising or even removing air conditioning from their facilities. The running and maintenance cost of a system that provides comfort to around only 80% of the occupants is often not the best option especially as we can in many cases provide a non air conditioned system that is extremely low in running and maintenance costs yet still provides comfort to 80% of the occupants.

The latest legislation on building design and mandatory reporting as well as mooted future legislation is going to see your facilities need to become a lot more resource efficient. In a very short period of time! Sustainability in buildings is in many ways going to be mandated whether we like it or not as it is the easiest and most cost effective way for the government to control carbon emissions.

In addition the changing market perception of a need for inhabitant comfort and healthy internal environment quality will ensure the sustainable facility, whether new or refurbished, is future proofed.

The shift in understanding and a desire to do the best for both the inhabitants, our world and the financial viability of the facility over the next thirty years has finally combined to ensure many facility owners make a smart decision and consider sustainability in their next project.

A welcome revolution in thinking and wisdom. n


the Evolution of Health Care training

the health care industry is changing and one education system doesn’t fit all. People can now have access to online courses and distance education taught by leading universities and higher education providers around the

country. Courses such as nursing, public health and health promotion can now be taught online.

Health care is by far one of the fastest growing industries out there and anyone choosing to enter healt hcare is essentially future-proofing their career. The US Bureau of Labor Statistics expects meteoric growth at 22 percent through 2016. That is twice the average for nearly all other industries.

In health care, your salary depends almost entirely upon education and training and an online education is often becoming the solution of choice for many people. In the health care field, obtaining an online degree is now easier and faster than the more conventional means of attending a university or a registered training organisation. For this reason, students are now flocking to online learning courses.

There are currently over 4 million students enrolled in online schools and universities and this number is growing by 30% per year.

So what is causing this evolution in health care training and why is it that students like online learning so much? To answer this, it is important to understand the benefits of online training:

Students can attend a course at any time, from anywhere.•Online learning enables student-centred teaching approaches because every •student has their own way of learning that works best for them.Course material is accessible 24 hours a day, 7 days a week.•In an online environment, it increases student interaction and the diversity •of opinion because everyone gets a say, not just the most talkative.

Online instructors allow students to be exposed to knowledge that can’t be •learned in books becausethe practical knowledge may be from any location around the globe.Using the internet to attend class, research information and communication •with other students teaches skills in using technologies.Participating online is much less intimidating than ‘in the classroom’.•Because online institutions often offer ‘chat rooms’ for informal •conversation, there appears to be an increased bonding over traditional class environments.The online environment makes instructors more approachable.•Online course development allows for a broad spectrum of content.•Because everyone gets a chance to contribute, students are less irritated with •those that ‘over contribute’ and can ask for clarification of any comments that are unclear.Online classrooms can facilitate team learning by providing chat rooms and •newsgroups for meetings and joint work.Students often comment that online learning lets them attend in increments •of convenient time blocks.Because there are no geographic barriers to online learning, students can •find diversity of course material that may not be available to them where they live or work.

While ‘face-to-face’ training will never be eliminated, it’s easy to see why a growing number of health care facilities are choosing to train their care staff online. They may be for reasons such as accessibility, flexibility or quality; all compelling and contributing to the attractiveness of this mode of learning.

Wellness & Lifestyles Australia is an example of a company that is embracing this concept and bringing the aged care industry into the 21st century with online education. To find out more, visit http://www.wleducation.com.au, or call their head office in South Australia on 08 8331 3000. n

aged care australia winter 2010

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